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by Tomoko McGaughey, MPH, MSc Student

In the fall of 2021 I was assigned as a Teaching Assistant for an undergraduate class where the students are building their skills in research, including the developing a research proposal as a group project. It has been amazing to see how much interest and knowledge these students carry in different areas of health, ranging from maternal health impacts on fetal development, air quality and lung health, or the gastrointestinal effects of ginger beer. To see this kind of work so early in their academic career has shown me that the next generation will go amazing places as their knowledge basis grows.

This experience has also highlighted the importance of teaching young academics about ethics early in their careers. It is not surprising that early undergraduates lack a comprehensive picture of research ethics and health equity ā€“ and it has prompted me to think about what training or guidance might be useful for students at this stage.

Students in Health Sciences are clearly interested in making the world better for individuals who are marginalized or underserved, and there they demonstrate a large appetite for learning. However, no matter how well meaning our research is, it doesnā€™t mean we can ignore that we are hoping to do research on fellow human beings who have thoughts, feeling and their own struggles they are experiencing daily. Further, that doesnā€™t mean we can remain ignorant of our own shortcomings when it comes to research ethics and engaging with people who are different than us.

Considerations for Research Ethics

According to (RN, PhD, Ryerson University), there are .

• First, is to protect human participants,
• Second is to ensure that research is conducted in a way that serves interests of individuals, groups and/or society as a whole, and
• Third is to examine specific research activities and projects for their ethical soundness (e.g. management of risk, protection of confidentiality, and process of informed consent).

Although some efforts have been made by students based on these three objectives, the route some students have chosen illustrates that they do not fully understand the impact their work may have on individuals and the groups they are trying to serve, and that they do not have insights from this community.

My concerns in how ethics is approached lie in the way we are looking at engaging with those whose lives we are studying. We require a sound, ethical process to engage with ANY community ā€“ let alone those who are often under or poorly served by the health system or seen as potentially vulnerable.

Questioning your own research

In line with teachings from early on in my academic career, and the objective presented by Dr. Walton, I ask myself three questions when considering the ethics of a research project, placing myself in the participants shoes:

1. Would I feel like this research project is causing not only myself but my community any harm (physical or emotional)?
2. Do I feel like I am being ostracised because of how I identify?
3. Am I respecting the autonomy of this community group and taking into consideration any historical vulnerabilities they may have experienced?

Patient engagement

In addition to the above, it is extremely important to consult with any communities before considering conducting research on them. This perspective is foundational in the shift to across the health sciences. At the outset, engagement could simply include a series of conversations and/or focus groups, including general community members and individuals who are identified to be leaders or informed on the topic you are researching, sampling their opinion on issues that should be addressed through research. Things like language to be used or avoided, references, important events or cultural considerations, and/or individuals that should be taken into consideration during the research process can be captured through the research process, when they may not have been identified otherwise.

Taken further, patient engagement could include the incorporation of individuals through the research process, either through study design planning, data collection, and data analysis so the communityā€™s perspective is considered throughout the whole research process. This continued consultation and reiteration process can allow communities to have their voice heard in a way that is respectful to their boundaries and experiences. This engagement is essential when  communities, and I completely see why and the importance behind it. When systems consistently threaten your autonomy, silence your advocacy, or neglect and even threaten your health, we need to ensure our research does not replicate this same system.

Final thoughts

Since coming to ŠÓ°ÉŌ­““, I have seen how the student, administrative, and teaching bodies of this university are extremely inclusive, supportive, accepting and understanding. This is something that drew me to ŠÓ°ÉŌ­““ and I want to do my part to ensure that this inclusiveness extends to health research, and how students are learning about the ethics of what they are being trained for. I can see how our undergraduate students are very well-meaning, want to change the world for the better, and improve the quality of life of those in their local communities. However, I hope that while these young scholars are exploring their dreams, they will continue to consider the implications of their work on those around them.

At the end of the day, I’ve written this short post because I not only care about protecting those who are vulnerable when it comes to research, but also because I care about the futures of the students around me. You all have a bright future but letā€™s try to make our work more inclusive and understanding as we move forward in this already very scary world.

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As a PhD student with mental health challenges, I sometimes question whether my experience is the same as my peers. Did they look for a supervisor who understands mental health?  Do they see themselves reflected in resources about ā€˜caring for your mental healthā€™ and ā€˜self-care for studentsā€™?

Donā€™t get me wrong, entering a PhD and being me has been remarkably rewarding. I have a supportive environment to explore my ideas, where my strange questions can lead to insightful conversations. Iā€™ve met peers who not only accept and encourage me but challenge my conceptualization of the world and my approach to research. I have a supervisor who sees value in my perspectives and believes in me. When applying to ŠÓ°ÉŌ­““, I was even exposed to . In essence, it feels like my potential in defining myself as an academic is limitless. While Iā€™m still waiting for this to come crashing down (Iā€™ve heard this happens in second year), I canā€™t help but think itā€™s the contrast between the supportive spaces Iā€™ve found and the concessions Iā€™ve had to make that makes my disappointment sting all the more.

At times, it can feel like the very institution of academia doesnā€™t accept me, and that even with acceptance, inclusion isnā€™t guaranteed and support is strictly rationed. For example, despite publishing an article on , ŠÓ°ÉŌ­““ā€™s counselling services arenā€™t set up to provide long-term support ā€“ which automatically necessitates that I seek support off campus. In order to pay for therapy, Iā€™ve had to label myself on provincial and school documentation as having a disability (regardless of whether I identify as that). While Iā€™m grateful for the support thatā€™s offered, the process of being forced into a label has sucked.

While writing this, the qualitative researcher in me couldnā€™t help but see the underlying theme in my experiences ā€“ the disconnect between the people and the system. My social and academic environments are ones of support and collaboration, where being me is a strength. How, then, have our institutional processes and policies not caught up?

These systemic barriers probably wonā€™t change anytime soon (or maybe they will, and Iā€™d be thrilled to be wrong here) but here are steps that prospective and current PhD students can take to protect or maintain their mental health based on my own experience:

Prospective students:

1. Include what you need (for your mental health) as a criterion in your search for the perfect supervisor or school.
2. Have open conversations with your potential supervisor about mental health. See if they are open to using different approaches to support you.
3. See if you can speak to a current graduate student about their experience. This can help you get a feel for the lab culture, and if it would be a supportive and inclusive environment.

New students:

1. Get registered with your university accessibility services as quickly as you can. Your disability coordinator can help you navigate OSAP and the NSLSC.
2. Think about moving your health information to Health Services on campus. This can be helpful for coordinating your services and setting up a comprehensive circle of care.
3. Pay attention to when bursaries open and close at your university. There are usually programs or bursaries that are specifically for helping people with disabilities.
4. See if you qualify for any of the awards .
5. Be open with your supervisor. Itā€™s not all sunshine and daisies and sometimes they can suggest strategies to help you cope.
6. Establish your support network prior to entering the program. Your supervisor isnā€™t your therapist, and it can be easy to cross boundaries and over-share if you donā€™t have solid supports in place prior to starting the program. Further, Iā€™ve found it hard to connect with peers if they donā€™t share similar life experiences and have relied on my friends more than ever.

The items in this list came from hours wading through blogs and Reddit treads (which, frankly, are often gloomy) and conversations with other folks who have been there, done that. As such, this isnā€™t a prescriptive list outlining the steps to success for PhD students with mental health concerns, but rather steps that have been helpful for me so far. I hope these lists might even slightly reduce the amount of labour necessary for our participation in academia. At the heart of it, I write this because, at the end of the day, we belong here.

Mel Edwards is a first year PhD Student in the Spatial Determinants of Health Lab. Her research interests include the use of e-mental health to support underserved populations in rural communities

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It has been an absolute pleasure to work as a part of the Spatial Determinants of Health lab over the past summer. Through the I-CUREUS award, I was able to work with Dr. Paul Peters and an MSc student, Maria Tovar Hidalgo, on a scoping review that examined oral health inequities within rural regions of Canada. The goal of this research was to assess how rurality can affect oral health experiences and outcomes in comparison to urban areas. The research also aims to contribute interventions which have improved poorer oral health outcomes within similar rural communities in countries like Australia, Sweden, and Norway. My work on this project primarily focused on conducting a literature search and extracting subsequent data which would be included in the scoping review.

Before this experience, I had only performed literature reviews for my health science courses and over the summer I was able to familiarize myself with research tools, such as , and gain a practical understanding of how policy research is composed. I quickly learned that every step within the process of synthesizing data is thorough, and that collaboration is key when it comes to being successful within health research.

I was fortunate to have joined a lab in which I was able to not only collaborate with Maria as often as I had but one in which we could discuss our research within lab meetings and troubleshoot any issues or challenges that might have come up within all of our various research projects. Dr. Paul Peters also maintained a lab environment that prioritized the success and wellbeing of all researchers. I was overwhelmed with the number of resources available at the beginning of the summer that would help me navigate health research and the tools he supplied to encourage better mental health management. I am grateful to have had such a supportive lab and mentor as part of my first research experience.

Some interesting things that I learned within my lab were how to adjust and calibrate a search string so that the resulting literature would become increasingly relevant to what I was searching for. As well, I learned about a multitude of comorbidities within oral health, a field that I was not very familiar with before this project, and about the innovative ways in which oral health could be improved, down to the fluoridation of drinking water. I went into this lab with some understanding about how rurality and access to care can affect health outcomes, however, I was challenged to learn about an entirely different field of public health than what I was exposed to within my classes. Through my participation in this research, I familiarized myself with the scope of oral health within the context of effective health policy development.

This experience allowed me to develop my critical thinking, organization, and time management skills. I was also exposed to a variety of research questions when going through published articles which I am inspired to pursue within my later career. I hope to apply these skills within my future in healthcare and to find many more opportunities as enriching as my time within this research lab.

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Rachpaul CC, Sendanyoye C, Mahling A, Sourial M, & Trto S. (2021). ā€œReport: Service Provision for Children and Youth with Disabilities in Rural Canada and Australia.ā€ Spatial Determinants of Health Lab, ŠÓ°ÉŌ­““ University: Ottawa ON. DOI: 10.22215/sdhlab/2021.2.

A full PDF of this report is also available.

BACKGROUND

Children and youth with disabilities residing in rural and remote regions of Canada and Australia are faced with limited availability and accessibility of appropriate allied health services. As a result, children and families oftenfacing difficulties obtaining a timely diagnosis (1) and experience fewer options for support services compared to their urban counterparts (2-6). Common accessibility barriers include geographic isolation, limited transportation options, long travel distances, limited number of available health care providers, increased wait times to obtain services, and high costs for appropriate services (6,7). Health service provision that takes into consideration rural and remote contexts is required to mitigate challenges imposed by geographic location.

There is limited data available regarding the prevalence of children and youth with disabilities in rural and remote communities. A greater understanding of existing resources to support children and youth with disabilities in hard-to-reach areas warrants further investigation.  To better inform this topic, a structured scoping review and thematic analysis was conducted.

Additionally, there are challenges in adequately collecting data pertaining to children and youth with disabilities. Much of this challenge is due to the lack of consensus regarding the inclusion of disability types and classifications. The UN Convention of the Rights of Persons with Disabilities (8) and the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) developed a definition of disabilities by combining pertinent elements of the definition (1). Disability is defined as, ā€œchildren and adolescents who require additional resources because of exceptional gifts and talents, physical, sensory, cognitive and learning challenges, mental health issues as well as problems due to social, cultural, linguistic or family factorsā€ (2).

This report summarizes the complete scoping review aims to provide a clear understanding of allied health service provision for children and youth with disabilities living in rural and remote communities in both Canada and Australia. This is accomplished through a comprehensives synthesis and comparative analysis of the existing literature, including identifying gaps in the literature and recommendations for future research and policy improvement.

KEY FINDINGS

SOLUTIONS AND BARRIERS

The scoping review process resulted in 33 peer-reviewed articles met inclusion criteria. The thematic analysis identified both successes and barriers to allied health service provision in rural areas pertaining to three key service needs: 1) diagnostics and assessments, 2) service availability, and 3) service accessibility. The review identified 7 major barriers and 5 major solutions in establishing adequate health service for children and youth residing in rural and remote Canada and Australia, as outlined in the figure below.  Service modality was identified as a major finding in playing a significant role in addressing barriers, with finding supportive technology and mixed modes of service provision as a solution.

Findings suggest inadequate service availability in rural communities for children and youth with disabilities because of the following:

• Disadvantages in obtaining diagnosis;
• Limited support services due to geographic isolation, transportation, and travel barriers;
• Limited number of available health care providers; and,
• Increased time and cost associated with obtaining services (1, 2-7).

Articles reported numerous solutions to address the above domains. Telepractice and technology-based programs are presented as being the single reported solution in all three major domains (9, 13, 16-24). This potential solution addresses both in-person and telehealth programs having the potential to be effective for diagnostic and assessment purposes (15-18).  The solution of utilizing the internet and social media breaks service availability barriers in improving child communication skills, its aim to improve parentā€™s knowledge of their childā€™s diagnosis, and collaboration between families and service providers (10-12,14, 20, 25-27).

Lastly, the solution of telepractice services improves service accessibility for children with disabilities in rural communities (13).  Technological integration into rural communities can be utilized to improve access to occupational therapy and the engagement of mental health services (13, 28-30). Barriers to service accessibility can be addressed by improving training, infrastructure, education on attitude change towards technological advancements, and ensuring cultural and linguistic diversity (31).

FURTHER CONSIDERATIONS

There has been increased attention being paid to children and youth with disabilities over the past decades as evidenced from this review. The data collected for children and youth with disabilities in rural communities of Canada are sparse, making it difficult to ascertain research and policy needs.

This review provides an overview of existing problems and possible resolutions in improving both research and policy for children and youth with disabilities in rural Canada and Australia. The literature on this topic primary focuses on research in Australia. Future Canadian research can learn from both the successes and ongoing challenges in Australia. In addition, research within a Canadian context should incorporate provinces and territories that are neglected in this field of study. Through building on existing research and discovering new opportunities, rural health policy can be better informed. This can be accomplished via collaboration between communities, researchers, stakeholders and policy makers. Although ongoing challenges exists within diagnostic and assessment, service availability and service accessibility; through innovative services and strengthening resources within communities, rural-centered delivery models for children and youth with disabilities in Australia and Canada can be developed.

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Academics with ADHD: Making the university workplace more accessible for neurodivergent people

Attention Deficit Hyperactivity Disorder (ADHD) is now one of the most diagnosed neurological conditions in children and can have significant impacts on individuals throughout their lives. Symptoms were once thought to reduce with maturity, however itā€™s now recognised that symptoms persist throughout the lifecourse. This has resulted in many people not being diagnosed until later in life, and I am one of those people.

In early 2019 my partner was looking into explanations for some of the difficulties my son (now 11) was facing in school and completed a parent-report ADHD questionnaire, but it wasnā€™t just my son that scored high. I was at work when she texted and asked me to complete the adult questionnaire for myself ā€“ it was life-changing. I was diagnosed by a psychologist in 2019 and have been receiving ADHD-specific psychotherapy and taking stimulant medication for the last 2 years. I have embarked on a process of self-discovery, recognising that many of the challenges Iā€™ve faced in my personal and professional life are related to this specific neurological impairment. In this talk I will talk about some of these challenges, how Iā€™ve adapted and ā€˜maskedā€™ in the past, and what workplace supports have helped now that I have a diagnosis.

Youtube Video:

(Talk begins at 3:21, Presentation at 7:23)

Presentation Slides: PDF version of my presentation

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Mara Elizabeth Margareta Ostafichuk, 1995 – 2021

ŠÓ°ÉŌ­““ and Health Sciences recently lost a member of the community recently with the death of Mara Ostafichuk, aged 25. Mara was a PhD student under Dr. Paul Peters in the Spatial Determinants of Health Lab and a research scholar with the Free Range International Knowledge Exchange. Passionate about social equity and improving access to public health services, Mara was active participant in international rural research and recently travelled with students to Iceland to see other rural health systems first-hand. Mara was a friend to many in Health Sciences and a regular fixture in our research computing lab and will be missed. The complete obituary can be found on .

Below is a photo from our 2019 trip to Iceland with Free Range scholars. Mara (3rd from left) had always dreamed of travelling to Iceland and had planned to conduct PhD research there. We all have strong memories of our time with Mara there and are continuing our work with her values in mind.

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Barnabe J., Petrie S., & P. Peters. 2020. Virtual Triage and Teletriage in Rural Canada and Australia: A Rapid Review. Spatial Determinants of Health Lab Ottawa, ON. doi: 10.22215/sdhlab/2020.2.

A complete PDF is also available for download.

Public Health Topic

Health care services and healthcare infrastructure in rural areas is continuously adapting in to meet the needs of rural and remote populations. Rural populations are unique and diverse, where there is a diversity of individuals within communities, and an equivalent diversity between communities. There are documented differences in health behaviours, health literacy, perceived health, and health outcomes between and within rural regions and rural communities. While geographic accessibility is often considered the primary driver, differences go beyond distance and include elements of demographic change, economic restructuring, and continued reductions in health and services.

The features of rural health care delivery are further underscored in the wake of the COVID-19 global health pandemic, a rapidly evolving situation which is undoubtedly putting pressure on already strained rural emergency departments (ED). In attempts to alleviate strain on front-line health provision and ensure the safety of the public, many healthcare facilities have rapidly implemented or have scaled-up eHealth solutions such as virtual triage and urgent care systems. These are virtual (virtual triage) or telephone systems (teletriage) in which patients can contact a physician or other healthcare professional who will guide them to appropriate care. The objective of these interventions is most often to reduce the overall number of in-person visits to EDs, potentially tackling ED overcrowding and misuse.

Current Knowledge

Overcrowding, long wait times, and lack of resources is a persistent issue in countries with publicly guaranteed health systems, with EDs being disproportionately affected. This is especially prevalent in rural Canada and Australia, where rural healthcare access and resources are limited. Although it is a complex problem, one of the main contributing factors to this pressure is the growing number of patients presenting to EDs with non-urgent complaints, many of whom are seeking primary care. Although seeking non-urgent care from the emergency department is seen as inappropriate to health system planners, it is often the only choice rural patients have. Over 4.7 million Canadians do not have a primary care provider and only 25% report they have a usual place of care such as an urgent care clinic, a luxury that is hard to come by in rural areas. A similar reality is seen in Australia, where access to general practitioners in regional or remote areas is limited, with many reporting visiting EDā€™s because a general practitioner was not available.

Initiatives such as telehealth and virtual visits have been suggested to bridge the gaps seen in rural healthcare and are part of broader eHealth initiatives that include electronic medical records, remote health monitoring, and other electronic health technologies. Identified benefits of using eHealth services for primary care provision include reducing the burdens that come with travelling long distances, increasing access to care, and cost savings across various domains. Despite perceived benefits, implementation is often non-existent, difficult, or slow. Cost, technological issues, and slow acceptance by providers is a recurring issue for successful long-term eHealth implementation.

Teletriage and virtual triage are eHealth initiatives proposed to mitigate rural healthcare gaps. Teletriage is the use of telephone conferencing services to guide patients to appropriate care based on patient presentation, the urgency of the condition, and the policy of the organization. Virtual triage is where secure video connections are integrated with secure voice. Various telephone triage initiatives have been slowly developed and implemented across Canada, and Australia. Despite the evidence of success with teletriage, virtual and video integration with these systems has been met with resistance, with few adopting it. However, amid the COVID-19 pandemic, Canadian and Australian healthcare providers have been advised to provide virtual care where possible, resulting in the rapid creation and scaling up of exiting teletriage platforms and integration of virtual triage.

Key Evidence

• Telephone triage (teletriage) has been slow to expanded in Canada and Australia.
• Teletriage is effective, safe, with high levels of reported patient satisfaction.
• Teletriage can provide an alternative to primary acute care when not available.
• Virtual triage is recent with most new platforms implemented due to the COVID-19 pandemic.
• Integration of video creates multiple layers of care, further improving effectiveness.
• Many of the limitations of tele- and virtual triage are related to existing inequalities in rural areas.
• Tele- and virtual systems can be effective at deferring patients from emergency departments.

Policy Recommendations

• Platforms need to be flexible, responsive, and tailored to regional circumstances
• Successful platforms are locally-based
• Leadership across stakeholders is essential to success
• Platforms are partnerships and collaborations
• Advertising and messaging are important
• Platforms use and create data, which must be analysed continuously

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Sinclair L, LeBlanc M, Sendanyoye C, & PA Peters. (2019). Rural Youth Health in Canada, Sweden, and Australia. Spatial Determinants of Health Lab, ŠÓ°ÉŌ­““ University: Ottawa, ON. DOI: 10.22215/sdhlab/2019.6

A high-quality PDF of this report with references is available for download.

The small size coupled with remoteness of rural communities in Canada, Australia, and Sweden introduce challenges in accessing sufficient health services (1-3). The sparse health services in rural areas impose ā€œthe tyranny of distanceā€ on rural and remote populations, necessitating lengthy travel times to receive care. Despite the increased challenges rural communities face, a dearth of research on rural health persists, particularly rural youth health (4,5).

A broad scoping review was undertaken to identify literature regarding rural youth health in Canada, Australia, and Sweden. The studies were coded according to population focus, health focus, access, and general. The scoping review produced the Rural Youth Health Scoping Review Database, which provides an overview of the available research on rural youth health.

STATE OF THE RESEARCH 

Physical health was researched most for rural youth, followed by mental health. Sexual health, substance use, and recreation were also included in studies, but were studied much less than the first two categories.

More than half of the articles included in the database focused on specific populations. Indigenous peoples and gender studies were the most prevalent categories, followed by refugees/immigrants, LGBTQ, and racism.

Codes related to access to care included travelling to receive healthcare, waitlists limiting access, recruitment and retainment of health care professionals, eHealth initiatives, and specialist availability. Specialist availability was the most studied category, with 71 articles mentioning specialists in the abstract. Travel and eHealth were also prevalent topics, with a smaller number of articles discussing waitlists and recruitment and retention.

INDIGENOUS HEALTH STUDIES

In the Canadian territories, health outcomes and life expectancy decrease as the percentage of Indigenous people increases (2). In Nunavut, where Indigenous people make up 85% of the population, the life expectancy at birth is 11 years lower than the Canadian average (2). The most frequently studied subpopulation of rural populations are Indigenous populations. The health foci of studies in Indigenous populations differ from the general population.

A higher number of studies on substance abuse in Indigenous populations have been conducted compared to the general population, while the general population has an increased number of studies regarding mental health. The findings suggest that the root structural causes of health issues, such as racism and mental health, may not be sufficiently and properly studied (6,7). Additionally, although suicide is often portrayed in the Canadian media in reference to Indigenous youth and Indigenous communities, the rates of studies regarding suicide in Indigenous-specific abstracts and general abstracts are proportionally the same. In order to improve the current state of research regarding Indigenous youth health, an exploration of the interaction between root structural problems and Indigenous health should be conducted.

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Reflecting on an I-CUREUS Internship

by Mikayla Young, May 2020

The year 2019-2020 has brought with it many new experiences and challenges; however, one of the most notable opportunities I have received this year was being able to be part of a social sciences research team. This inter-disciplinary team led by Dr. Paul Peters is based in the Department of Health Sciences and combines social science research with data analysis, community engagement, and hypothesis-driven evidence evaluation. The project in which I am a part of, is exploring the evidence for recruitment and retention of mental health care practitioners in rural and remote communities.

Through the I-CUREUS ā€˜Free Rangeā€™ program, I was table to accompany my fellow student researchers and Dr. Paul Peters to Akureyri, a small town in Northern Iceland, in order to further explore rural health and well-being in a practical setting. This training-oriented trip gave us the opportunity to learn and hear firsthand about the lives and experiences of the individuals living remotely. Part of this program was to speak with a diversity of people. This included an opportunity to speak at length with the head mistress of the , which has won numerous awards for . The headmistress, LĆ”ra StefĆ”nsdĆ³ttir, was also in charge of the local dispatch and organization of the search and rescue team. This was an invaluable experience, in which I gained so much knowledge and interesting learning opportunities. It was also a great chance to further my understanding of the research I am doing and allowed me to better my understanding of the context of rural and remote living.

Shortly after returning from Iceland, I traveled with fellow students and Professor Paul Peters to Golden Lake, Ontario. There, I was given the opportunity to work with the other students in running a day-long workshop regarding rural health. The day consisted of directed exercises and table discussions on different topics and sectors of rural health. During this time, the other students and myself led these discussions and took notes on the responses of the local participants at our tables.

The workshop was successful and had many willing and knowledgeable participants who were and are continuing to actively work in the pursuit to better their health care systems, and access to adequate and appropriate care rurally. This was a great experiential learning opportunity and worked well to provide myself with a contextual foundation for doing social research as well as rural health research.

Currently, working alongside graduate student Claudia Sendanyoye, I am conducting a title screening and structured scoping review on pre-existing research and literature written on this topic. A scoping review is meant to ā€œexamine the extent (that is, size), range (variety), and nature (characteristics) of the evidence on a topic or question; determine the value of undertaking a systematic review; summarize findings from a body of knowledge that is heterogeneous in methods or discipline; or identify gaps in the literature to aid the planning and commissioning of future researchā€ (Tricco, A. 2028, p.467) The methods for scoping review differ depending on the topic being explored.

Scoping reviews require several different steps and methods to obtain the desired outcome of the research in which you are studying. Some of these different methods include: ā€œfocus on a specific topical area, a well-defined research question, rationale regarding inclusion and exclusion criteria, and clearly defined procedures and responsibilities for all researchersā€ (Peterson, J. 2016. p.13). As Claudia and I already have a well-defined research question outlined, we are now in the step of the methodology where we are in the process of discussing and outlining all rationale for inclusion, and exclusion.

Some of the challenges which we faced during this process, were narrowing down our search terms. Initially, we received a lot of literature from our searches that were not applicable to our research question. However, after changing small things, and taking away certain words that changed the outcome in our searches, we were able to greatly limit this and filter our results. Although, there were still many articles uncovered that did not pertain to our project. It was important for us to be specific regarding which articles could be applicable and which could not be. The blurred lines there often posed a challenge during this stage.

I am excited to continue moving forward in this project and to continue to grow and learn during the process. Claudia and I will now move forward in working on the next stages of our methodology, before identifying the key indicators, trends and patterns for recruitment and retention for mental health care practitioners, followed by charting and graphing the results.

References

Peterson, J., Pearce, P., Ferguson, L. & Langford C. (2016) Understanding Scoping Reviews: Definition, Purpose, and Process. Journal of The American Association of Nurse Practitioners. 12-16. doi:10.1002/2327-6924.12380

Tricco, A., Lillie E., Zarin W., Oā€™Brien, K., Colquhoun, H., Levac, D., Moher D., Peters. M., Horsley, T., Weeks, L., Hempel, S., Chang, C., McGowan, J., Stewart, L. Hartling, L., Aldcroft, A., Wilson, M., Garritty, C., Lewin, S., ā€¦Straus, S. (2018) Research and Reporting Methods. Annals of Internal Medicine. 467-485. doi:10.7326/M18-0850

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