The COVID-19 pandemic highlighted the need for practical digital health tools to support informed decision-making amidst rapidly evolving evidence and widespread misinformation. We iteratively developed and refined VaxDA-C19, a bilingual (English and French) web-based patient decision aid designed to support informed decision-making in Canada about COVID-19 vaccination. VaxDA-C19 integrates interactive and personalized features aimed to enhance vaccine confidence, reduce cognitive overload, and respond to diverse informational needs. We developed VaxDA-C19 using an iterative, user-centered design approach. Throughout the development process, we involved a citizen panel, healthcare professionals, user experience designers, and scientific experts to guide refinements. We also conducted usability testing sessions with adults in Canada, using semi-structured interviews, comparative testing, and think-aloud protocols with thematic analysis. We ultimately conducted four design cycles in total: three with adults in Canada (cycle 1: n=9 users; cycle 2: n=22 users; cycle 3: n=3 users), one overlapping and one additional cycle with expert reviewers (cycle 3: n=5; cycle 4: n=9). In Cycle 1, user feedback guided design decisions about how to present quantitative information and technical vaccine descriptions more simply. In Cycle 2, while most users (82%) favored in-depth explanations of vaccine development, a few raised concerns about content that could be perceived as politically charged. Cycle 3 identified usability improvements, including more explicit navigation controls, simplified medical terminology, and optimized interactive components (avatars, sliders). Expert reviews in Cycle 4 refined linguistic consistency, mobile responsiveness, content transparency, and scientific accuracy, emphasizing explicit instructional guidance and bilingual accessibility. Our iterative process produced a personalized, bilingual digital decision aid to support evidence-informed, values-congruent decisions about COVID-19 vaccination. A randomized controlled trial will further evaluate VaxDA-C19's impact on vaccination intentions, knowledge retention, emotional responses, decisional conflict, and decisional regret. If it proves effective, the patient decision aid may also be used as a platform to support other vaccine decisions, namely, influenza, measles, shingles, pertussis, and potentially other emerging infectious diseases.

INTRODUCTION:Disparities in COVID-19 vaccination coverage emerged during the vaccination campaign. This study aimed to assess whether inequalities in COVID-19 vaccination coverage in Canada persisted or resolved throughout the vaccine rollout. METHODS:Using data from the Canadian Community Health Survey, the analysis included people 18 and older from all ten provinces. Vaccination coverage for at least one dose of a COVID-19 vaccine was determined in three periods: June 2021-February 2022 (n = 28,182), February-June 2022 (n = 25,742), and July-December 2022 (n = 23,119). Statistically significant gaps across groups were assessed using non-overlapping 95 % confidence intervals (CI). RESULTS:In June 2021-February 2022, coverage for at least one dose (95 % CI) was 85.5 % (79.0-90.3) for off-reserve First Nations people, 85.7 % (79.6-90.1) for Métis people, 79.6 % (72.1-85.4) for Black people, 83.0 % (72.9-89.9) for Arab people, and 92.9 % (92.3-93.5) for White people. By July-December 2022, coverage was 87.4 % (80.2-92.3), 90.5 % (85.5-93.8), 92.1 % (87.2-95.2), 95.6 % (90.6-98.0), and 95.1 % (94.5-95.6), respectively, in the same populations. The gap between off-reserve First Nations and White people remained significant, at 7.4 percentage points (pp.) in the first period and 7.6 pp. in the third period. As for Métis and White people, the gap decreased from 7.3 pp. to 4.6 pp. In the first period, the gap compared to White people was 13.4 pp. for Black people and 9.9 pp. for Arab people, and resolved in the third period. Significant gaps also remained across age groups, levels of educational attainment, household income, for those residing in rural areas, those living with children under 12 years old, and those without a regular healthcare provider. CONCLUSION:Despite efforts to address them, several inequalities persisted throughout the vaccine rollout, underscoring the need for refined strategies to reach all population segments. As Canadian vaccination registries do not collect sociodemographic data beyond date of birth, sex and place of residence, survey data is needed to measure these disparities.

Background. Chiropractors and homeopaths are trusted sources of health information for many Canadians, including around vaccination. However, within Ontario, Canada, the College of Chiropractors of Ontario and the College of Homeopaths of Ontario regulations state that vaccines are not within their scope of practice and providers should not express views, treat, or advise patients with respect to vaccination. The aims of the present study were to: (1) describe the attitudes and beliefs regarding vaccination held among participating chiropractors and homeopaths; (2) identify the sources of information about vaccination they trust and use to guide their personal vaccination decisions; and (3) describe how they navigate patient requests for guidance on vaccine decision-making within the current regulatory landscape. Methods. Semi-structured interviews (N = 16) were conducted between February 2020-March 2021 and explored participants’ opinions on vaccination, sources of information they trust and recommend to their patients, and how they navigate vaccine conversations with patients. Results. Providers’ personal beliefs regarding vaccination were described as reinforced by social and professional networks, through their personal experiences, and in consultation with clients. Various strategies were used to support patients while abiding by regulations (e.g. referring patients to providers for whom vaccination is within their scope of practice); however, other strategies described (e.g., stating personal beliefs) could be interpreted as a breach of regulation. Conclusions. This research reinforces existing literature suggesting that patients using chiropractors and homeopaths have questions about vaccination and are looking for trusted information. Public health services should consider engaging with chiropractors and homeopaths to facilitate communication between patients and immunization providers.

Research partnerships between researchers and knowledge users are increasingly valued for their role in generating relevant and impactful research. However, the dynamics of these partnerships, including motivations, challenges, and relational aspects, remain underexplored. This study aimed to understand the experiences of researchers and knowledge users engaged in partnered child health research. We used an interpretive description approach to conduct and analyze semi-structured interviews with researchers and knowledge users involved in Canadian partnered child health research projects. Data analysis was iterative, involving inductive coding, theme development, and reflection with an interprofessional colleague with lived experience of a congenital health condition. Fifteen individuals (12 researchers and 3 knowledge users) participated. We identified three key themes. (1) Diverse drivers: role-based motivations and perceived effects – Participants described diverse, role-based motivations for engaging in partnered research. Researchers were primarily driven to enhance research impact, while knowledge users emphasized advocacy and credibility. Individuals embodying dual roles with research expertise and professional experience focused on practical relevance and improving health outcomes. (2) It’s all about the relationships – Relational quality was central to successful partnerships. While power dynamics shifted towards greater equity over time, achieving fully equitable relationships remained complex. (3) Navigating evolutions and tensions – Academic structures continue to create tensions despite a growing cultural shift toward embracing partnership approaches. Key challenges included insufficient recognition for partnership efforts, and funding mechanisms often misaligning with partnership principles. This study underscores the importance of understanding role-specific motivations, prioritizing relational quality, and addressing systemic challenges in child health research partnerships. Findings provide insights into key dynamics that help navigate both successes and challenges in these partnerships. Continued efforts are needed to address misalignments across systems and structures, support relationship building, and promote sustained collaboration. In health research, researchers, patients, families, and healthcare professionals work together more often to ensure that results make a difference in the real world. We know that these partnerships have become more common, but we do not know why people work together, their challenges, and what makes partnerships successful. To learn more, we interviewed 15 Canadian researchers and people involved in child health research partnerships. A colleague living with a congenital health condition collaborated with us to analyze the data and explain the findings. We learned three main things. First, people were motivated to partner for different reasons. Researchers wanted to make their work more useful, while knowledge users often wanted to advocate for change. Some participants had research skills and professional experiences, giving them a unique view of practical research with tangible outcomes. Second, university and government funding systems have not adapted to the needs of researchers and knowledge users working together. For example, these projects require significant time and effort, but working together is not always recognized by universities. Finally, strong relationships are central to working together. Trust, respect, and fairness are the foundation, but these relationships take time to develop. Balancing power between researchers and knowledge users is another challenge. This study highlights the importance of understanding people’s motivations for engaging in research partnerships, improving how they are supported, and prioritizing strong, respectful relationships.

Objectives Indigenous peoples, like Red River Métis, were greatly affected by COVID-19. Manitoba’s Indigenous COVID-19 vaccine policy initially focused exclusively on First Nations. Red River Métis, one of Canada’s recognized Indigenous peoples, were not prioritized. We examined the health outcomes of these policy decisions. Method This retrospective cohort study leveraged data available in the Manitoba Population Research Data Repository. We linked data from the Métis Population Database to whole-population COVID testing and vaccination data, and administrative data on health service use. Restricted mean survival time models tested whether vaccination uptake differed between Red River Métis and all other Manitobans (AOM), adjusting for sociodemographic characteristics and comorbidities. A Susceptible-Exposed-Infected-Recovered-Vaccinated model simulated how prioritizing Red River Métis for vaccination at the same time as First Nations may have altered the pandemic curve. We used estimates to model associated reductions in health service use for Red River Métis. Results Cumulative prevalence of COVID-19 infection rates were similar between Métis and AOM until May 2021 when rates became higher among Métis. Between May and December 2021, rates of first vaccination were lower among Metis than AOM. Métis were more likely than AOM to be hospitalized due to Covid-19 between March and August 2021 and visit physicians for COVID related reasons from October 2020 to Feb 2021 and November 2021 to March 2022. Simulation analyses showed that prioritizing Red River Métis at the same time as First Nations would have reduced the peak infection rate by 54.6% reducing health service use. Conclusions Understanding the experiences of Red River Métis relative to AOM is critical to identifying public health strategies which close gaps in vaccine uptake and infections. Including Red River Métis with other Indigenous populations may have reduced adverse outcomes and health service use associated with COVID-19.

Poor website accessibility and usability with credible website/information sources can create barriers to the equitable uptake of vaccines. Scarce research investigates how intended users interact with and perceive official COVID-19 websites. We examine how people in Canada interact with official COVID-19 vaccine websites and how they use information to inform their choices regarding COVID-19 vaccinations. Using a qualitative design and talk-aloud (also called ‘think-aloud’) method, we conducted interviews with 50 general population individuals residing in 3 provinces in Canada in July-December 2021, during which they navigated specific government websites and attempted to find information on various aspects of COVID-19. During the interviews, participants were given specific tasks (e.g. searching for specific information on the websites) and asked to ‘think aloud’ while performing them. Thematic content was used to identify positive and negative elements regarding the websites that were stated by participants as they navigated the websites. Our analysis demonstrated that participants appreciated websites that featured user-friendly and aesthetically pleasing designs, had local and updated information, offered links to reputable sources, and dispelled misconceptions. Participants also critiqued sites for using technical jargon, presenting seemingly insufficient information, and potentially having conflicts of interest. These findings underline the need for health authorities to prioritize web-based communication and understand the information needs of their audience. Ignoring user preferences raises potential risks of poor communication, such as leaving their citizens seeking information elsewhere.

Testing for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) using dried blood spot (DBS) specimens has been an integral part of bio-behavioural surveillance in Canada for almost two decades, though less is known regarding the use of DBS in surveillance of other sexually transmitted and blood-borne infections (STBBI). A systematic review was conducted using a peer-reviewed search strategy to assess the current evidence regarding the validity of STBBI testing using DBS specimens. Eligibility criteria included studies reporting use of DBS specimens for STBBI testing with either commercially available or “in-house” tests in populations 15 years of age or older. Studies reporting a measure of validity such as sensitivity, specificity, positive and negative predictive values were eligible for inclusion. Quality of studies and risk of bias were assessed using the QUADAS-2 tool. A total of 7,132 records were identified. Of these, 174 met the criteria for inclusion. Among the studies that reported validity measures, a substantial proportion demonstrated high sensitivity (≥90%) in 62.5% of cases (N= 334/534 sensitivity measurements), and high specificity (≥90%) was observed in 84.9% of instances (N= 383/451 specificity measurements). However, the quality of the studies varied greatly. Our findings support the validity of the use of DBS specimens in STBBI testing where sufficient evidence was available, but validity is highly dependent on thorough method development and validation.

Most research that includes Red River Métis tends to be pan-Indigenous. Grouping Métis with First Nations and Inuit can diminish their unique and diverse experiences, as well as distinctions-based approaches. Taking a step toward addressing this problem, the Manitoba Métis Federation (MMF; the national government of the Red River Métis) invited researchers within the Canadian network Translating Emergency Knowledge for Kids to partner in this research, which focuses on understanding engagement strategies that can help expose Red River Métis parents to child health research opportunities and build trust and transparency amongst research partners and participants. A qualitative descriptive approach underpinned by a participatory paradigm guided this study. Semi-structured interviews were conducted with 19 Red River Métis parents and Elders via Zoom or telephone. An inductive thematic analysis approach was used to explore patterns and themes across the data. Analysis generated four themes: (a) show me why you are here; (b) make it easier for me to take part; (c) create welcoming spaces; and (d) it should be a give and take experience. Parents emphasized the importance of kinship and personal connections, and said they want to hear about child health study opportunities from trusted organizations. They want researchers to be transparent about their research motivations and to offer multiple ways to participate to help them fit research into their busy lives. Relational approaches within the research process (e.g., creating informal/welcoming environments, gathering over food, fostering shared learning/creative opportunities) are prominent in the findings. There is a dearth of research focused on the distinct experiences of Red River Métis families. Engaging Red River Métis parents early in the research process will help incorporate their preferences and perspectives into the design of a larger project to adapt child health resources. More training is needed to help researchers improve their abilities to engage in self-reflection, listen, recognize power relationships, and demonstrate trust and transparency in each research interaction. It is only through respectful and successful engagement that child health research can be relevant, applicable and positively impact Red River Métis children, families and communities. Most research involving Red River Métis tends to group them together with First Nations and Inuit, which can overlook their unique experiences. To address this, the Manitoba Métis Federation (the national government for the Red River Métis) invited us to collaborate on a study. This research focuses on finding ways to engage Red River Métis parents/families in child health research, aiming to build trust and openness between research teams and participants. We interviewed 19 Red River Métis parents and Elders in the Canadian province of Manitoba. We asked them how to improve access to and participation in child health research. We analyzed the data to identify common themes and patterns. Four main themes emerged: (a) show me why you are here; (b) make it easier for me to take part; (c) create welcoming spaces; and (d) it should be a give and take experience. Parents stressed the importance of personal connections and wanted to hear about child health research opportunities from trusted sources. They wanted transparency from researchers about their motives and flexible participation options due to their busy lives. Building relationships during research is important, such as through informal gatherings and shared learning experiences. Researchers need more training to reflect on their own biases, listen effectively, and foster trust and transparency in their interactions. Engaging Red River Métis parents early in the research process is crucial to incorporating their views into a larger project to adapt child health resources.

Research partnerships between researchers and knowledge users (KUs) in child health are understudied. This study examined the scope of KU engagement reported in published child health research, inclusive of health research partnership approaches and KU groups. Search strategies were developed by a health research librarian. Studies had to be in English, published since 2007, and were not excluded based on design. A two-step, multiple-person hybrid screening approach was used for study inclusion. Data on study and engagement characteristics, barriers and facilitators, and effects were extracted by one reviewer, with 10% verified by a second reviewer. Three hundred fifteen articles were included, with 243 (77.1%) published between 2019 and 2021. Community-based participatory research was the most common approach used (n = 122, 38.3%). Most studies (n = 235, 74.6%) engaged multiple KU groups (range 1-11), with children/youth, healthcare professionals, and parents/families being most frequently engaged. Reporting of barriers and facilitators and effects were variable, reported in 170 (53.8%) and 197 (62.5%) studies, respectively. Publications have increased exponentially over time. There is ongoing need to optimize evaluation and reporting consistency to facilitate growth in the field. Additional studies are needed to further our understanding of research partnerships in child health.

Background In Part I of this review, we outlined the study characteristics and methodologies utilized in adaptive clinical trials reported in the literature from 2010–2020. Herein, the second part of this analysis presents a secondary analysis of the trials captured within this timeframe that enrolled children. Methods This analysis seeks to generate an evidence base that can inform practical recommendations that can shape the design, ethical considerations, and training on methods and reporting for pediatric adaptive design (AD) trials. We performed a secondary analysis of 43 AD trials involving children and compared the study characteristics with those of adult AD trials. Results There were one to five arms in these pediatric AD trials, with the most commonly reported adaptive methods being dose modifications (20/43, 46.5%) in dose-finding trials, followed by continual reassessment method (CRM), a model-based Bayesian design, reported in 20 studies (46.5%), and adaptive randomization (9/43, 20.9%). The frequentist framework (68.8%) was most commonly used for statistical analysis. Reporting indicated a lack of patient and parent engagement with clinicians and scientists during the clinical trial (CT) planning process and was only reported in 1 of the reviewed studies (1/43, 2.32%). Conclusion We reviewed examples of the most common types of adaptive designs used in pediatric trials and compared the methods used with adults’ trials. Against this background, we provide an overview of the different statistical approaches used and highlight the ethical considerations. The results of this review could serve as a reference for the development of guidelines and training materials to guide clinical researchers and trialists in the use of pediatric adaptive clinical trials. Study protocol registration: DOI: 10.1186/s13063-018-2934-7

Identifying effective interventions to promote children’s vaccination acceptance is crucial for the health and wellbeing of communities. Many interventions can be implemented to increase parental awareness of the benefits of vaccination and positively influence their confidence in vaccines and vaccination services. One potential approach is using narratives as an intervention. This study aims to evaluate the effects of a narrative-based intervention on parents’ attitudes and vaccination intentions. In a pre-post experiment, 2,000 parents of young children recruited from an online pan-Canadian panel were randomly exposed to one of the three videos presenting narratives to promote childhood vaccination or a control condition video about the importance and benefits of physical activity in children. Pre-post measures reveal a relatively modest but positive impact of the narratives on parents’ attitudes and intention to vaccinate their child(ren). The results also suggest that narratives with more emotional content may be more effective in positively influencing vaccine attitudes than the more factual narrative. Using narratives to promote vaccination can positively influence parents’ views and intentions toward childhood vaccines, but research is still required to identify the best components of such interventions.

We examined the perspectives of the Red River Métis citizens in Manitoba, Canada, during the H1N1 and COVID-19 pandemics and how they interpreted the communication of government/health authorities' risk management decisions. For Indigenous populations, pandemic response strategies play out within the context of ongoing colonial relationships with government institutions characterized by significant distrust. A crucial difference between the two pandemics was that the Métis in Manitoba were prioritized for early vaccine access during H1N1 but not for COVID-19. Data collection involved 17 focus groups with Métis citizens following the H1N1 outbreak and 17 focus groups during the COVID-19 pandemic. Métis prioritization during H1N1 was met with some apprehension and fear that Indigenous Peoples were vaccine-safety test subjects before population-wide distribution occurred. By contrast, as one of Canada's three recognized Indigenous nations, the non-prioritization of the Métis during COVID-19 was viewed as an egregious sign of disrespect and indifference. Our research demonstrates that both reactions were situated within claims that the government does not care about the Métis, referencing past and ongoing colonial motivations. Government and health institutions must anticipate this overarching colonial context when making and communicating risk management decisions with Indigenous Peoples. In this vein, government authorities must work toward a praxis of decolonization in these relationships, including, for example, working in partnership with Indigenous nations to engage in collaborative risk mitigation and communication that meets the unique needs of Indigenous populations and limits the potential for less benign-though understandable-interpretations.

Background Despite high COVID-19 vaccine coverage in Canada, vaccine acceptance and preferred delivery among newcomers, racialized persons, and those who primarily speak minority languages are not well understood. This national study explores COVID-19 vaccine acceptance, access to vaccines, and delivery preferences among ethnoculturally diverse population groups.Methods We conducted two national cross-sectional surveys during the pandemic (Dec 2020 and Oct-Nov 2021). Binary logistic regression analysis investigated the association between newcomer, language, and racialized minority respondents’ perceptions and acceptance of COVID-19 vaccines, experiences of discrimination when accessing health services, and sociodemographic characteristics. McNemar-Bowker tests were used to assess changes in responses collected at two time points.Results Among 1630 respondents, 30.8% arrived in Canada within the last five years, 87.4% self-identified as a racialized minority, and 37.2% primarily spoke languages other than English or French. Although single dose COVID-19 vaccine uptake was at 92.7% among respondents, 14.8% experienced difficulty accessing vaccines, citing a need for translated resources or multi-lingual personnel. In longitudinal analysis, respondents were increasingly motivated over time to overcome barriers to accessing vaccines (61.4% to 69.6%, p = <.001). Fifty-nine percent (59.9%) of respondents would accept annual vaccination and over half would accept co-administration with routine (56.2%) or influenza (52.3%) vaccines. Experiences of racism/discrimination upon health service access were reported by 12.3% of respondents, who recommended increasing culturally safe practices and community involvement at vaccination sites.Conclusions Understanding how newcomers, racialized peoples, and minority language speakers perceive and access COVID-19 vaccines will support vaccination campaigns to optimize equitable access.

BackgroundGamification has been used successfully to promote various desired health behaviors. Previous studies have used gamification to achieve desired health behaviors or facilitate their learning about health. ObjectiveIn this scoping review, we aimed to describe digital gamified tools that have been implemented or evaluated across various populations to encourage vaccination, as well as any reported effects of identified tools. MethodsWe searched Medline, Embase, CINAHL, the Web of Science Core Collection, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Academic Search Premier, PsycInfo, Global Health, and ERIC for peer-reviewed papers describing digital gamified tools with or without evaluations. We also conducted web searches with Google to identify digital gamified tools lacking associated publications. We consulted 12 experts in the field of gamification and health behavior to identify any papers or tools we might have missed. We extracted data about the target population of the tools, the interventions themselves (eg, type of digital gamified tool platform, type of disease/vaccine, type and design of study), and any effects of evaluated tools, and we synthesized data narratively. ResultsOf 1402 records, we included 28 (2%) peer-reviewed papers and 10 digital gamified tools lacking associated publications. The experts added 1 digital gamified tool that met the inclusion criteria. Our final data set therefore included 28 peer-reviewed papers and 11 digital gamified tools. Of the 28 peer-reviewed papers, 7 (25%) explained the development of the tool, 16 (57%) described evaluation, and 2 (7%) reported both development and evaluation of the tool. The 28 peer-reviewed papers reported on 25 different tools. Of these 25 digital gamified tools, 11 (44%) were web-based tools, 8 (32%) mobile (native mobile or mobile-enabled web) apps, and 6 (24%) virtual reality tools. Overall, tools that were evaluated showed increases in knowledge and intentions to receive vaccines, mixed effects on attitudes, and positive effects on beliefs. We did not observe discernible advantages of one type of digital gamified tool (web based, mobile, virtual reality) over the others. However, a few studies were randomized controlled trials, and publication bias may have led to such positive effects having a higher likelihood of appearing in the peer-reviewed literature. ConclusionsDigital gamified tools appear to have potential for improving vaccine uptake by fostering positive beliefs and increasing vaccine-related knowledge and intentions. Encouraging comparative studies of different features or different types of digital gamified tools could advance the field by identifying features or types of tools that yield more positive effects across populations and contexts. Further work in this area should seek to inform the implementation of gamification for vaccine acceptance and promote effective health communication, thus yielding meaningful health and social impacts.

Approximately 7% of children live with food allergy, a condition that requires dietary avoidance to prevent an allergic reaction. In this qualitative study, we aimed to understand food allergy-related experiences, beliefs and learning preferences among children with and without food allergies, to inform a school-based, food allergy education program. Data were analysed thematically. We virtually interviewed children in Kindergarten-Grade 8 in Manitoba, Canada, with (n = 7) and without (n = 9) parent-reported, physician-diagnosed food allergies. We identified three themes: Naive reliance on peers and school staff to assist with food allergy management; Limited food allergy knowledge; and, Recommended food allergy curricula: complementary perspective. Our findings will help inform the development of a school-based, food allergy education program, with a long-term goal of minimizing food allergy-related worries and optimizing safety for children with food allergy. Ongoing, school-based food allergy education is needed.

Systematically marginalized populations, like Red River Métis, have been greatly affected by COVID-19. Manitoba’s Indigenous COVID-19 vaccine policy initially delayed prioritization of Métis. Our research team, which included Métis partners, examined the consequences of these decisions (COVID-19 infections, health service use, vaccine uptake) among Métis, and how earlier prioritization could have improved outcomes. This retrospective cohort study linked data from the Métis Population Database to whole-population COVID testing and vaccination data, and administrative data on health service use. Restricted mean survival time models tested whether vaccination uptake differed between Métis and all other Manitobans (AOM), adjusting for sociodemographic characteristics and comorbidities. A Bayesian model will simulate how prioritization of Métis for vaccination two weeks earlier could have impacted infections. Cumulative prevalence of COVID-19 infection rates were similar among Métis and AOM until May 2021 when rates became higher among Métis. Between May and December 2021, rates of first vaccination were lower among Metis than AOM, as were second vaccination rates between July and November 2021. Métis were more likely than AOM to be hospitalized due to Covid-19 between March and August 2021 and visit physicians for COVID related reasons from October 2020 to Feb 2021 and November 2021 to March 2022. Our analyses simulated what would have occurred had Métis been prioritized for vaccination two weeks before AOM, alongside other Indigenous peoples. Understanding the experiences of Métis relative to AOM is critical to identifying public health strategies which close gaps in vaccine uptake and infections.

Objective and ApproachTo address the opioid crisis within the Red River Métis (RRM) Community, understanding opioid use is crucial to empower regional health authorities to adapt health programs, services, and policies to meet their unique needs effectively. The investigation utilized focus groups with a Community-Based Participatory Research and Collective Consensual Data Analytics Procedure (CBPR/CCDAP) approach. Additionally, a population-based retrospective cross-sectional study for fiscal years 2006/07–2018/19 was conducted using administrative data from a population research data repository. Rates of prescription opioid dispensing (RPOD) and mean morphine equivalents (MEQ) were compared between RRM and all other Manitobans (AOM) aged 10 years or older. ResultsThe rate of prescription opioid dispensing and MEQ/person were found to be consistently higher among RRM compared to AOM in each study year (p < 0.001). While the RPOD declined among AOM over the study period, it did not change among RRM. Key findings revealed RRM were concerned about how opioids impacted their communities, and felt the need for increased addiction treatment resources, including Red River Métis culture-specific programs. ConclusionThe evidence demonstrates higher RPOD and MEQ among RRM compared to AOM, suggesting elevated risk of opioid-related harms. Focus group feedback reinforces the need for tailored interventions. ImplicationsFuture policies and programs targeting the opioid crisis should prioritize the unique needs of populations like the RRM, requiring tailored, culturally appropriate interventions for effective crisis management.

The arrival of COVID-19 vaccines in Canada marked the first time since the H1N1 influenza pandemic that adult vaccination became central in public health discourse, thus evoking feelings and discourse about individuals' responsibility to get vaccinated. Public health institutions made efforts to ensure vaccines were accessible, and various local organizations worked to fill gaps in accessibility (e.g. vaccine clinics for equity-denied communities). However, despite knowledge of barriers to accessing healthcare, and specifically vaccines, public and health discourses emphasized individual objection as the main barrier to optimal vaccine uptake. This study explored how individuals who identified as a racialized minority or Indigenous person, perceived their personal responsibility to get vaccinated. We gathered perspectives in qualitative interviews (N = 27) when vaccines were first becoming available to adults living in Canada (May-June 2021). Theory about moral regulation, risk governance, and emotion informed our analysis. Findings suggest that individuals engaged in the governance of oneself and others towards getting vaccinated. However, participants also critiqued discourses that hold individuals responsible for accessing vaccines. They identified substantial barriers to accessing vaccines for individuals with fewer resources (e.g. travel time, missing work, childcare). When referencing individuals who do not know how to access information about vaccination, one participant stated, 'it's really embarrassing [& mldr;] to ask for help.' Feelings of individual responsibility may prevent some people uncertain about vaccines from asking for more information and support. We argue that the focus on vaccine hesitancy without attention to systemic barriers deflects responsibility for making vaccines accessible from centralized institutions to individuals.

Background:To evaluate the effects of a web-based, personalized avatar intervention conveying the concept of community immunity (herd immunity) on risk perception (perceptions of the risk of infection spreading (to self, family, community, and vulnerable individuals)) and other cognitive and emotional responses across 4 vaccine-preventable disease contexts: measles, pertussis, influenza, and an unnamed "vaccine-preventable disease." Methods:Through a robust user-centered design process, we developed a web application, "herdimm," showing how community immunity works. In our application, people personalize a virtual community by creating avatars (themselves, 2 vulnerable people in their community, and 6 other people around them; e.g., family members or co-workers.) Herdimm integrates these avatars in a 2-minute narrated animation showing visually how infections spread with and without the protection of community immunity. The present study was a 2×4 factorial randomized controlled trial to assess herdimm's effects. We recruited 3883 adults via Qualtrics living in Canada who could complete an online study in English or French. We pre-registered our study, including depositing our questionnaire and pre-scripted statistical code on Open Science Framework (https://osf.io/hkysb/). The trial ran from March 1 to July 1, 2021. We compared the web application to no intervention (i.e. control) on primary outcome risk perception, divided into objective risk perception (accuracy of risk perception) and subjective risk perception (subjective sense of risk), and on secondary outcomes-emotions (worry, anticipated guilt), knowledge, and vaccination intentions-using analysis of variance for continuous outcomes and logistic regression for dichotomous outcomes. We conducted planned moderation analyses using participants' scores on a validated scale of individualism and collectivism as moderators. Results:Overall, herdimm had desirable effects on all outcomes. People randomized to herdimm were more likely to score high on objective risk perception (58.0%, 95% confidence interval 56.0%-59.9%) compared to those assigned to the control condition (38.2%, 95% confidence interval 35.5%-40.9%). Herdimm increased subjective risk perception from a mean of 5.30 on a scale from 1 to 7 among those assigned to the control to 5.54 among those assigned to herdimm. The application also increased emotions (worry, anticipated guilt) (F(1,3875)=13.13, p<0.001), knowledge (F(1,3875)=36.37, p<0.001) and vaccination intentions (Chi-squared(1)=9.4136, p=0.002). While objective risk perception did not differ by disease (Chi-squared(3)=6.94, p=0.074), other outcomes did (subjective risk perception F(3,3875) = 5.6430, p<0.001; emotions F(3,3875)=78.54, p<0.001; knowledge (F(3,3875)=5.20, p=0.001); vaccination intentions Chi-squared (3)=15.02, p=0.002). Moderation models showed that many findings were moderated by participants' individualism and collectivism scores. Overall, whereas outcomes tended not to vary by individualism and collectivism among participants in the control condition, the positive effects of herdimm were larger among participants with more collectivist orientations and effects were sometimes negative among participants with more individualist orientations. Conclusions:Conveying the concept of community immunity through a web application using personalized avatars increases objective and subjective risk perception and positively influences intentions to receive vaccines, particularly among people who have more collectivist worldviews. Including prosocial messages about the collective benefits of vaccination in public health campaigns may increase positive effects among people who are more collectivist while possibly backfiring among those who are more individualistic.

Background Little is known about how intersecting social privilege and disadvantage contribute to inequities in COVID-19 information use and vaccine access. This study explored how social inequities intersect to shape access to and use of COVID-19 information and vaccines among parents in Canada. Methods We conducted semi-structured interviews on COVID-19 vaccination information use with ethnically diverse parents of children ages 11 to 18 years from April to August 2022. We purposefully invited parents from respondents to a national online survey to ensure representation across diverse intersecting social identities. Five researchers coded transcripts in NVivo using a discourse analysis approach informed by intersectionality. Our analysis focused on use of vaccine information and intersecting privileges and oppressions, including identifying with equity-denied group(s). Results Interview participants ( N = 48) identified as ethnically diverse non-Indigenous ( n = 40) and Indigenous ( n = 8) Peoples from seven Canadian provinces. Racialized minority or Indigenous participants reflected on historical and contemporary events of racism from government and medical institutions as barriers to trust and access to COVID-19 information, vaccines, and the Canadian healthcare system. Participants with privileged social locations showed greater comfort in resisting public health measures. Despite the urgency to receive COVID-19 vaccines, information gaps and transportation barriers delayed vaccination among some participants living with chronic medical conditions. Conclusion Historicization of colonialism and ongoing events of racism are a major barrier to trusting public health information. Fostering partnerships with trusted leaders and/or healthcare workers from racialized communities may help rebuild trust. Healthcare systems need to continuously implement strategies to restore trust with Indigenous and racialized populations.