Kasaai et al describe the career trajectories of embedded scientists trained through the Health System Impact Fellowship (HSIF), showing that 37% of 2017-2019 HSIF alumni continue as embedded researchers in health systems. These findings suggest that the HSIF program effectively supports career readiness in health services and policy research (HSPR). Similarly, the Network of Scholars (NoS) program, launched post-pandemic in Nova Scotia, mirrors these results, with alumni continuing in embedded roles and mentoring a new cohort of learners from undergraduate to postgraduate levels. NoS has incorporated competencies in quality, project management, and innovation to strengthen training for embedded scientists, aligning with the mandate of the Institute of Health Services Policy and Research. Since 2021, NoS has supported over 100 learners, contributing to over 300 rapid reviews and 100 rapid evaluations addressing top health system priorities while enhancing learner competencies and advancing Nova Scotia's Learning Health System (LHS) vision.

Objective To understand how lack of attachment to a regular primary care provider influences patients' outlooks on primary care, ability to address their health care needs, and confidence in the health care system. Design Qualitative descriptive study using semistructured interviews. Setting Canadian provinces of Nova Scotia, Ontario, and Quebec. Participants Patients aged 18 years or older who were unattached or had become attached within 1 year of being interviewed and who resided in the province in which they were interviewed. Methods Forty-one semistructured interviews were conducted, during which participants were asked to describe how they had become unattached, their searches to find new primary care providers, their perceptions of and experiences with the centralized waiting list in their province, their experiences seeking care while unattached, and the impact of being unattached on their health and on their perceptions of the health care system. Interviews were transcribed and analyzed using a thematic approach. Main findings Two main themes were identified in interviews with unattached or recently attached patients: unmet needs of unattached patients and the impact of being unattached. Patients' perceived benefits of attachment included access to care, longitudinal relationships with health care providers, health history familiarity, and follow-up monitoring and care coordination. Being unattached was associated with negative effects on mental health, poor health outcomes, decreased confidence in the health care system, and greater pre-existing health inequities. Conclusion Having a regular primary care provider is essential to having access to high-quality care and other health care services. Attachment also promotes health equity and confidence in the public health care system and has broader system-level, social, and policy implications.

Nova Scotia's Supportive Care Program (SCP) is an individualized funding program that provides funds for people living with dementia (PLWD) or acquired brain injuries to purchase basic home care services such as personal care, respite, cleaning and cooking. The SCP has the potential to address the Quintuple Aim of enhancing care experience, improving population health, reducing costs, improving provider experience and improving health equity, yet qualitative evidence is lacking. The aim of this study is to use participatory program evaluation methods to evaluate the SCP and consider how effective it is in addressing the Quintuple Aim. The study objectives and corresponding methods are to (1) Co-develop a SCP logic model to guide the evaluation through consultations with a diverse group of stakeholders including PLWD, caregivers, care providers, researchers, government representatives, and nongovernment organizations, with attention to gender; (2) Evaluate the SCP based on the outcomes and outputs identified in the logic model using focus groups with PLWD, caregivers and home care providers, and interviews with PLWD and their caregivers; and (3) Mobilize knowledge about the ways the SCP addresses the Quintuple Aim through integrated knowledge translation activities with public, policy and research audiences. By focusing on clinically and socially vulnerable populations of PLWD and caregivers, the proposed evaluation of the SCP offers a valuable case in assessing the effectiveness of individually-funded home care in addressing the Quintuple Aim including health equity within the context of dementia care.

INTRODUCTION:Engaging children and young people (CYP) with and without their parents in health research has the potential to improve the development and implementation of health interventions. However, to our knowledge, the scope of engagement activities used with this population and barriers to their engagement is unknown. The objective of this review was to identify and describe CYP engagement with and without their parents in the development and/or implementation of health interventions. METHODS:This scoping review included any primary research studies reporting on engaging CYP, with or without parents, in the design and/or implementation of health interventions. Healthcare professionals had to be involved over the course of the study and the study had to take place in either community, primary or tertiary care settings. The following databases were searched in May 2017, May 2020 and June 2021: Medline (OVID), CINAHL (EBSCO) and Embase (Elsevier). Two independent reviewers screened titles, abstracts and full-text articles and used a previously piloted extraction form to extract and summarize information from the included articles. RESULTS:Twenty-eight articles discussing twenty-four studies were included. CYP engagement throughout the research cycle was limited. There were no observed differences in the reported presence of engagement, types of interventions or outcomes of engagement between studies engaging CYP or CYP and parents. Studies engaging CYP and parents contained limited information on how these relationships affected outcomes of engagement. Engagement was enabled primarily by the maintenance of resources and relationships among stakeholders. CONCLUSIONS:Although CYP engagement often influenced health intervention and implementation design, they are inconsistently engaged across the research cycle. It is unclear whether parental involvement enhances CYP engagement. Future research should consider reporting guidelines to clarify the level of CYP and/or parent engagement, and enhance CYP engagement by fostering synergistic and sustainable partnerships with key stakeholders. PATIENT OR PUBLIC CONTRIBUTION:A parent partner with codesign experience contributed to the creation of the research questions, screened titles, abstracts and full texts, helped with data extraction and provided feedback on the manuscript.

The Canadian Institutes of Health Research - Institute of Health Services and Policy Research's (IHSPR's) Strategic Plan 2021-2026 for accelerating health system transformation is well positioned to meet the strategic priorities being outlined by many health systems in Canada and internationally (CIHR IHSPR 2021). The IHSPR Health System Impact Fellow program has been a strong influence on the embedded research and scientist program in Nova Scotia, namely, the Network of Scholars Program, which was implemented just before the pandemic. The network includes scientists and scholars from diverse academic backgrounds and skill levels including alumni of the Health System Impact Fellow program. The Network of Scholars has over 30 scholars and approximately 100 academic partners and scientists supporting embedded activities such as rapid reviews, implementation science and rapid evaluation initiatives. These embedded activities are front facing to the needs and priorities of the health system. This commentary highlights the importance of IHSPR's outlined strategic plan and direction, which are consistent with the experience and the needs for embedded supports within the Nova Scotia health system.

"Policy capacity" describes the ability of policy-making systems to do quality work. Better-quality policy work leads to more successful policies. There have been limited attempts to operationalize theoretical understanding of policy capacity, resulting in a lack of shared understanding and assessment metrics. In this Delphi study, health policy experts validated an existing multidimensional conceptual framework for policy capacity. Factors that contribute to policy success were identified and rated to represent aspects of policy capacity, and arranged within the conceptual framework, as were factor indicators. The resulting tool provides expert-generated items for transparently and systematically assessing policy capacity.

In late January 2020, the first COVID-19 case was reported in Canada. By March 5, 2020, community spread of the virus was identified and by May 26, 2020, close to 86,000 patients had COVID-19 and 6,566 had died. As COVID-19 cases increased, provincial and territorial governments announced states of public health emergency between March 13 and 20, 2020. This paper examines Canada’s public health response to the COVID-19 pandemic during the first four months (January to May 2020) by overviewing the actions undertaken by the federal (national) and regional (provincial/territorial) governments. Canada’s jurisdictional public health structures, public health responses, technological and research endeavours, and public opinion on the pandemic measures are described. As the pandemic unravelled, the federal and provincial/territorial governments unrolled a series of stringent public health interventions and restrictions, including physical distancing and gathering size restrictions; closures of borders, schools, and non-essential businesses and services; cancellations of non-essential medical services; and limitations on visitors in hospital and long-term care facilities. In late May 2020, there was a gradual decrease in the daily numbers of new COVID-19 cases seen across most jurisdictions, which has led the provinces and territories to prepare phased re-opening. Overall, the COVID-19 pandemic in Canada and the substantial amount of formative health and policy-related data being created provide an insight on how to improve responses and better prepare for future health emergencies.

Integrated knowledge translation (iKT) refers to the engagement of knowledge users (e.g., policy makers, clinicians, patients) as active participants in the research process. Theoretically, this involvement enhances research relevancy and usefulness, thereby supporting health system change. However, evidence to support best practices for iKT is lacking, particularly in a public health context and with non-clinical decision-makers. The objectives of this research were to report how decision-maker involvement in public health iKT research has been described and operationalized and whether the process was evaluated. We conducted a scoping review of published literature from January 2005 to December 2017 and extracted information related to iKT involvement, barriers and facilitators and outcomes. Studies typically did not distinguish between different kinds of knowledge users, making it impossible to comment specifically on decision-makers' involvement. Authors believed knowledge user involvement was beneficial to the quality and potential impact of research activities, although corroborating evaluation data were unavailable. Broad research-knowledge user partnerships spanning multiple projects, as well as flexible involvement of knowledge users, enhanced engagement and supported the iKT process.

Background and Purpose: Over the last decade, the field of implementation science (IS) has yielded an array of theoretical approaches to clarify and understand how factors influence the application and scaling-up of evidence-based practice in health care. These developments have led to questions about whether IS theories and frameworks might be of value to population health researchers and decision makers. The purpose of this research was to conduct a critical interpretive synthesis to explore, if, and how, key IS theories and frameworks might inform population health interventions aimed at reducing the burden of illness across populations. Methods: An initial list of theories and frameworks was developed based on previous published research and narrowed to focus on theories considered as formative for the field of IS. A standardized data extraction form was used to gather key features of the theories and critically appraise their relevance to population health interventions. Results: Ten theories were included in the review and six deemed most applicable to population health based on their consideration of broader contextual and system-level factors. The remaining four were determined to have less relevant components for population health due to their limited consideration of macro-level factors, often focusing on micro (individual) and meso (organizational) level factors. Conclusions: Theories and frameworks are important to guide the implementation and sustainability of population health interventions. The articulation of meso level factors common in IS theories may be of value to interventions targeted at the population level. However, some of the reviewed theories were limited in their consideration of broader contextual factors at the macro level (community, policy or societal). This critical interpretive synthesis also found that some theories lacked provision of practical guidance to address interventions targeting structural factors such as key social determinants of health (e.g., housing, income).

Background and Purpose Over the last decade, the field of implementation science (IS) has yielded an array of theoretical approaches to clarify and understand how factors influence the application and scaling-up of evidence-based practice in health care. These developments have led to questions about whether IS theories and frameworks might be of value to population health researchers and decision makers. The purpose of this research was to conduct a critical interpretive synthesis to explore, if, and how, key IS theories and frameworks might inform population health interventions aimed at reducing the burden of illness across populations. Methods An initial list of theories and frameworks was developed based on previous published research and narrowed to focus on theories considered as formative for the field of IS. A standardized data extraction form was used to gather key features of the theories and critically appraise their relevance to population health interventions. Results Ten theories were included in the review and six deemed most applicable to population health based on their consideration of broader contextual and system-level factors. The remaining four were determined to have less relevant components for population health due to their limited consideration of macro-level factors, often focusing on micro (individual) and meso (organizational) level factors. Conclusions Theories and frameworks are important to guide the implementation and sustainability of population health interventions. The articulation of meso level factors common in IS theories may be of value to interventions targeted at the population level. However, some of the reviewed theories were limited in their consideration of broader contextual factors at the macro level (community, policy or societal). This critical interpretive synthesis also found that some theories lacked provision of practical guidance to address interventions targeting structural factors such as key social determinants of health (e.g., housing, income).

As our global population ages, physical activity has been found to be an important dimension of healthy aging. Many research fields use the terms “older adult” and “physical activity,” but differences in how these terms are defined and conceptualized can impair interpretation and comparison. As such, the purpose of this review was to determine how recent peer-reviewed articles defined, conceptualized, and operationalized the terms “older adult” and “physical activity.” Gaps in the literature resulting from considerable variation in term use and operationalization are discussed. Measures such as functional ability may be useful in addition to chronological age when describing a sample of “older adults,” while a number of age-specific considerations for physical activity measurement are presented. By illustrating the variability in how these two terms are used in the literature and outlining considerations for conceptualization and assessment, this article provides guidance for future study in the field of aging and physical activity.

Physical activity (PA) is an effective intervention for improving the quality of life of colorectal cancer survivors (CRC) and may reduce the risk of cancer recurrence and cancer specific and all-cause mortality. However, most CRC survivors are not sufficiently active to receive these benefits. Sedentary behavior (SB) has also been linked to morbidity and mortality risk independent of activity level, thereby presenting an additional opportunity to improve health outcomes of CRC survivors. The built environment is known to influence PA and SB; however, little is known about where CRC survivors engage in PA and SB. The objective of this exploratory study was to objectively identify locations where CRC survivors engage in PA and SB in order to inform health promoting interventions.

Background: Physical activity for persons with Parkinson Disease (PD) is recommended yet little is known about the physical activity levels in this patient population. The primary aim was to assess the feasibility of using a direct measurement and self-report measure of physical activity in patients with PD. Methods: Physical activity was recorded in 11 out-patients with mild to moderate PD. An accelerometer based sensor system (SenseWear Pro Armband?) which was worn continuously over 2 days was used to measure physical activity. Minute by minute energy expenditure and steps per day were recorded. Self-report physical activity was measured using the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH) which assessed average weekly activity. Results: Using the accelerometer based sensor system, 83% of the day was spent in sedentary activity with the majority active time spent at a light intensity (2.7 [SD 2.0] hrs/day). Self-reported mean number of hours for activities greater than 2.0 METs was 3.4 (SD 1.5) hrs/day. Although the overall time spent in activity did not differ between the accelerometer and SQUASH, partici- pants reported a higher proportion of activities at the moderate and vigorous intensities than the accelerometer recorded. Conclusions: Measurement of physical activity is a challenge in persons with PD given the disease-related symptoms. We found that, by all accounts, a self-report measure of physical activity should be complemented with a direct measure of physical activity.