The needs and preferences of Eastern Canadian sex workers in mitigating occupational health and safety risks through the use of Information and Communication Technologies: A qualitative study.

Sex workers may use Information and Communication Technology (ICT) as a means to mitigate occupational health and safety (OHS) risks by exchanging harm reduction techniques (e.g., screening) on blogs and social media. ICTs can also assist sex workers in creating online communities, where community members can act as each other's safety check-ins, an additional harm reduction technique. In Canada, there is a paucity of research around ICT usage by sex workers for managing occupational health and safety. The objective of this study was to qualitatively examine the needs and preferences of Canadian sex workers when using ICTs in the delivery of strategies for occupational health and safety. Using a theoretical framework derived from a Social Ecological Model perspective, semi-structured interviews were conducted via phone, with a mixed gender sample (N = 22) of sex workers, between April and July 2020. OHS risks were found to be related to structural determinants, client behaviours, and lack of experience and knowledge when newly entering sex work. Participant accounts revealed a socially cohesive online community; however, sex workers reported difficulties in finding these communities, particularly when entering sex work. Such barriers to supportive communities were attributed to the criminalized, hidden nature of sex work that resulted in the fragmentation of harm reduction techniques across several online platforms, such as blogs, YouTube videos, closed electronic chat groups, and open online sex worker supportive communities. Moreover, these platforms and/or their content could potentially disappear without warning, either due to the platform provider seeking to evade possible prosecution, or because new legislation was introduced banning such content. Recommendations for further research include the co-design with sex workers of an innovative, secure, easily accessible, sex worker-only ICT OHS tool, utilizing a web hosting service located in a country where sex work has been either legalized or decriminalized.

The Use of Information and Communication Technologies by Sex Workers to Manage Occupational Health and Safety: Scoping Review.

BACKGROUND: In many countries, sex work is criminalized, driving sex work underground and leaving sex workers vulnerable to a number of occupational health and safety risks, including violence, assault, and robbery. With the advent of widely accessible information and communication technologies (ICTs), sex workers have begun to use electronic occupational health and safety tools to mitigate these risks. OBJECTIVE: This study aims to explore the use of ICTs by sex workers for managing occupational health and safety risks and strategies for reducing these risks. This paper aims to answer the following question: what is known about sex workers' use of ICTs in the delivery of occupational health and safety strategies? METHODS: A literature review following the methodological framework for scoping reviews was conducted to analyze studies describing the use of ICTs by sex workers to mitigate occupational health and safety risks. Experimental, observational, and descriptive studies, as well as protocol papers, were included in this scoping review. RESULTS: Of the 2477 articles initially identified, 41 (1.66%) met the inclusion criteria. Of these studies, 71% (29/41) were published between 2015 and 2019. In these studies, the internet was the predominant ICT (24/41, 58%), followed by text messaging (10/41, 24%) and assorted communication technologies associated with mobile phones without internet access (7/41, 17%; eg, voice mail). In 56% (23/41) of the studies, sex workers located in high-income countries created occupational health and safety strategies (eg, bad date lists) and shared them through the internet. In 24% (10/41) of the studies, mostly in low- and middle-income countries, organizations external to sex work developed and sent (through text messages) occupational health and safety strategies focused on HIV. In 20% (8/41) of the studies, external organizations collaborated with the sex worker community in the development of occupational health and safety strategies communicated through ICTs; through this collaboration, concerns other than HIV (eg, mental health) emerged. CONCLUSIONS: Although there has been an increase in the number of studies on the use of ICTs by sex workers for managing occupational health and safety over the past 5 years, knowledge of how to optimally leverage ICTs for this purpose remains scarce. Recommendations for expanding the use of ICTs by sex workers for occupational health and safety include external organizations collaborating with sex workers in the design of ICT interventions to mitigate occupational health and safety risks; to examine whether ICTs used in low- and middle-income countries would have applications in high-income countries as a substitute to the internet for sharing occupational health and safety strategies; and to explore the creation of innovative, secure, web-based communities that use existing or alternative digital technologies that could be used by sex workers to manage their occupational health and safety.

Understanding the patient privacy perspective on health information exchange: A systematic review.

BACKGROUND: Health information exchange (HIE), the ability for health information technology (HIT) to share patient data, can improve the efficiency and effectiveness of healthcare; however, this ability may cause patient concern about their ability to control who can access their health records (i.e., privacy). These concerns may affect a patient's candor in their therapeutic patient-provider relationships, thereby undermining their care. While patient privacy concerns are often cited as a barrier to HIT implementation, the patient privacy perspective is not well understood. The purpose of this systematic review is to provide an in-depth exploration of the patient privacy perspective toward HIE, its antecedents, and its outcomes. MATERIALS AND METHODS: A systematic review was conducted on seven health sciences and interdisciplinary databases. Empirical studies that assessed the patient perception of privacy in context of interoperable HIT were included. All included articles were independently screened, extracted, and analyzed by two reviewers. The results were extracted and categorized based on the dimensions outlined in the Antecedent Privacy Concern Outcomes macro-model (APCO). RESULTS: Of the 1713 unique citations, 59 articles met the inclusion criteria which consisted of 39 (66.1%) quantitative studies, 15 (25.4%) qualitative studies, and 5 (8.5%) mixed methods studies. Fourteen articles (23.7%) were specifically focused on understanding privacy. The patient privacy perspective was operationalized in different ways, with privacy concern being the most common measure (25.4%). The percentage of participants expressing privacy concern ranged from 15% to 74%, depending on the study. Perceived quality of care was associated with lower privacy concerns. Privacy concerns were associated with privacy protective behaviours; however, the perceived benefit of HIE may mitigate the effects of privacy concern. CONCLUSION: Using the APCO as a guide, this review found that the patient privacy perspective is dynamic, complex, and still not well understood. There may be an oversimplification of the patient privacy perspective and its impact given the paucity of privacy-focused research. The evidence suggests patient perceptions of healthcare and the value of HIE are important factors in mitigating privacy concerns and its effects. More in-depth privacy studies are required to further illuminate the nuances of the patient perspective and provide policy-makers with greater insights on the privacy barrier.

Education programs for medical psychiatry collaborative care: A scoping review.

OBJECTIVE: To understand the current state of collaborative care education programs reported in the literature. METHODS: Following Arksey and O'Malley methodology for scoping reviews, data was abstracted in following domains: article details, program details, program outcomes, and implementation factors. Numerical summaries were calculated where necessary. Implementation factors underwent a qualitative thematic analysis. RESULTS: This review identified 40 unique collaborative care education programs. Most programs (n = 25; 62.5%) were delivered to a multi-disciplinary group of learners through didactic (n = 34; 85.0%) and/or in vivo (n = 32; 80.0%) training methods. The majority of programs focused on clinical knowledge/skill acquisition (n = 38; 95.0%) as opposed to attitudes towards mental health and collaboration (n = 27; 67.5%). Implementation factors fell within four themes: program development, supportive environment, necessary resources, and clinical change agents/leaders. CONCLUSION: Despite the growing evidence for collaborative care, few collaborative care education programs are reported in the literature. Key elements of collaborative care education programs include: routine multi-disciplinary interaction, curriculum focus on attitudes; clinical change agents and leaders to accelerate implementation; and a user-centred design development process. Future implementations can learn from these experiences to avoid potential barriers and focus on enabling successful programs to enhance care.

Scoping review protocol: education initiatives for medical psychiatry collaborative care.

INTRODUCTION: The collaborative care model is an approach providing care to those with mental health and addictions disorders in the primary care setting. There is a robust evidence base demonstrating its clinical and cost-effectiveness in comparison with usual care; however, the transitioning to this new paradigm of care has been difficult. While there are efforts to train and prepare healthcare professionals, not much is known about the current state of collaborative care training programmes. The objective of this scoping review is to understand how widespread these collaborative care education initiatives are, how they are implemented and their impacts. METHODS AND ANALYSIS: The scoping review methodology uses the established review methodology by Arksey and O'Malley. The search strategy was developed by a medical librarian and will be applied in eight different databases spanning multiple disciplines. A two-stage screening process consisting of a title and abstract scan and a full-text review will be used to determine the eligibility of articles. To be included, articles must report on an existing collaborative care education initiative for healthcare providers. All articles will be independently assessed for eligibility by pairs of reviewers, and all eligible articles will be abstracted and charted in duplicate using a standardised form. The extracted data will undergo a 'narrative review' or a descriptive analysis of the contextual or process-oriented data and simple quantitative analysis using descriptive statistics. ETHICS AND DISSEMINATION: Research ethics approval is not required for this scoping review. The results of this scoping review will inform the development of a collaborative care training initiative emerging from the Medical Psychiatry Alliance, a four-institution philanthropic partnership in Ontario, Canada. The results will also be presented at relevant national and international conferences and published in a peer-reviewed journal.