Development and validation of the Trust in Multidimensional Healthcare Systems Scale (TIMHSS).

CONTEXT: The COVID-19 pandemic has reignited a commitment from the health policy and health services research communities to rebuilding trust in healthcare and created a renewed appetite for measures of trust for system monitoring and evaluation. The aim of the present paper was to develop a multidimensional measure of trust in healthcare that: (1) Is responsive to the conceptual and methodological limitations of existing measures; (2) Can be used to identify systemic explanations for lower levels of trust in equity-deserving populations; (3) Can be used to design and evaluate interventions aiming to (re)build trust. METHODS: We conducted a 2021 review of existing measures of trust in healthcare, 72 qualitative interviews (Aug-Dec 2021; oversampling for equity-deserving populations), an expert review consensus process (Oct 2021), and factor analyses and validation testing based on two waves of survey data (Nov 2021, n = 694; Jan-Feb 2022, n = 740 respectively). FINDINGS: We present the Trust in Multidimensional Healthcare Systems Scale (TIMHSS); a 38-item correlated three-factor measure of trust in doctors, policies, and the system. Measurement of invariance tests suggest that the TIMHSS can also be reliably administered to diverse populations. CONCLUSIONS: This global measure of trust in healthcare can be used to measure trust over time at a population level, or used within specific subpopulations, to inform interventions to (re)build trust. It can also be used within a clinical setting to provide a stronger evidence base for associations between trust and therapeutic outcomes.

Examining vaccine hesitancy among a diverse sample of Canadian adults.

The aim of this study was to explore the sociodemographic and individual-level factors associated with vaccine hesitancy in general, including political affiliation and beliefs in vaccine conspiracy theories, in a diverse group of Canadian adults within the context of the COVID-19 pandemic. 641 responses were included in the analysis, with those self-identifying as Indigenous, Black Canadian, and low-income (household income <$40,000) being sampled to yield data from historically marginalized populations. Demographic variables and responses to questions on vaccine hesitancy, and beliefs in vaccine conspiracy theories were used to explore explanatory variables of vaccine hesitancy. General linear regression models were fit using the method of least squares via PROC GLM and used to examine sociodemographic and individual explanatory variables of vaccine hesitancy. Age, ethnicity, political affiliation, and beliefs in vaccine conspiracies were associated with vaccine hesitancy. Findings are discussed in relation to the critical role of distrust and misinformation in hesitancy. Our data provide insight into how Canadian provincial governments may promote uptake of vaccines in ways that target diverse groups that may differ from those developed in a pre-pandemic context.

Development and validation of the Trust in Government measure (TGM).

BACKGROUND: Trust in government is associated with health behaviours and is an important consideration in population health interventions. While there is a reported decline in public trust in government across OECD countries, the tools used to measure trust are limited in their use for informing action to (re)build trust, and have limitations related to reliability and validity. To address the limitations of existing measures available to track public trust, the aim of the present work was to develop a new measure of trust in government. METHODS: Fifty-six qualitative interviews (Aug-Oct 2021; oversampling for equity-deserving populations) were conducted to design a national survey, including factor analyses and validation testing (N = 878; June 1-14th 2022) in Canada. RESULTS: The measure demonstrated strong internal consistency (α = 0.96) and test validity (CFI = 0.96, RMSEA = 0.09, SRMR = 0.03), suggesting that trust in government can be measured as a single underlying construct. It also demonstrated strong criterion validity, as measured by significant (p < 0.0001) associations of scores with vaccine hesitancy, vaccine conspiracy beliefs, COVID-19 conspiracy beliefs, trust in public health messaging about COVID-19, and trust in public health advice about COVID-19. We present the Trust in Government Measure (TGM); a 13-item unidimensional measure of trust in Federal government. CONCLUSIONS: This measure can be used within high-income countries, particularly member countries within the OECD already in support of using tools to collect, publish and compare statistics. Our measure should be used by researchers and policy makers to measure trust in government as a key indicator of societal and public health.

Informing efforts beyond tailored promotional campaigns by understanding contextual factors shaping vaccine hesitancy among equity-deserving populations in Canada: an exploratory qualitative study.

BACKGROUND: Vaccine hesitancy exists on a continuum ranging between complete adherence and complete refusal due to doubts or concerns within a heterogeneous group of individuals. Despite widespread acknowledgement of the contextual factors influencing attitudes and beliefs shaping COVID-19 vaccine hesitancy, qualitative research with equity-deserving groups, accounting for unique lived experiences, remains a gap in the literature. We aim to identify and begin to understand and document the unique contextual factors shaping hesitancy by equity-deserving groups as it relates to relationships with government and health authorities. METHODS: Participants were recruited and interviewed between Aug-Dec 2021. Semi-structured interviews using a convergent interviewing technique were conducted with individuals from the general population, as well as individuals who identify as First Nations, Métis, or Inuit, members of the LGBT2SQ + community, low-income Canadians, Black Canadians, and newcomers. Interviews were audio recorded and transcribed by a team of researchers. Memos were written following interviews and used to complement the thematic analysis of the interview data. Themes are presented in the results section. RESULTS: The rationale for hesitancy among equity-deserving groups is consistent with literature documenting hesitancy in the general population. Contextual factors surrounding equity-deserving groups' attitudes and beliefs, however, are unique and relate to a history of oppression, discrimination, and genocide. We identified factors unique to subgroups; for example, religious or fatalistic beliefs among participant who identify as FNMI, fear associated with lack of testing and speed of vaccines' production among participants who identify as FNMI, Black, and LGBT2SQ + , distrust of the healthcare system for LGBT2SQ + and Black Canadians, and distrust of the government and opposition to vaccine mandates for participating who identify as LGBT2SQ + , low-income, FNMI, or Black Canadian. Newcomers stood out as very trusting of the government and accepting of COVID-19 vaccination. CONCLUSIONS: While our data on vaccine hesitancy largely mirror concerns reported in the vast body of literature citing rationale for COVID-19 hesitancy in high-income countries, the contextual factors identified in our work point to the need for wider systemic change. Our results may be used to support efforts, beyond tailored promotion campaigns, to support the confident acceptance of vaccines for COVID-19 and the acceptance of novel vaccines as future infectious diseases emerge.

Examining factors impacting acceptance of COVID-19 countermeasures among structurally marginalised Canadians.

The COVID-19 pandemic highlighted and exacerbated inequities in health for structurally marginalised Canadians. Their location on society's hierarchies constrained their ability to access healthcare and follow recommended health behaviours. The aim of this article is to identify, from the perspective of marginalised populations, factors influencing the acceptance or rejection of COVID-19 countermeasures by structurally marginalised Canadians. Interviews were conducted with Canadians 18 + who identified as Black (n = 8), First Nations, Métis, or Inuit (n = 7) and low-income (<40,000 annual household income) (n = 8) between August and December 2021. Measures were said to impact well-being and interfere with revenue generating activities. Longstanding unfavourable living and environmental conditions as they relate to structural marginalisation was said to fuel anger toward the government and lead to a greater reluctance to accept countermeasures. Participants described concerns about government decisions being made without considering their unique contexts, or knowledge of the experiences of the population for whom these decisions were being made. Effective proactive action from government is important to foster trust with marginalised populations to support acceptance of health information and address growing inequities. Action that demonstrates government competence and commitment to the interests of marginalised populations is critical.

Canadians' trust in government in a time of crisis: Does it matter?

The ability of governments and nations to handle crises and protect the lives of citizens is heavily dependent on the public's trust in their governments and related social institutions. The aim of the present research was to understand public trust in government during a time of crisis, drawing on interview data (N = 56) collected during the COVID-19 pandemic (2021). In addition to the general public (n = 11), participants were sampled to obtain diversity as it relates to identifying as First Nations, Métis, and Inuit (n = 7), LGBT2SQ+ (n = 5), low-income (n = 8), Black Canadians (n = 7), young adult (n = 8), and newcomers to Canada (n = 10). Data were coded in consideration of social theories of trust, and specifically the nature of trust between individuals and institutions working with government in pandemic management. Canadians' trust in government was shaped by perceptions of pandemic communication, as well as decision-making and implementation of countermeasures. Data suggest that although participants did not trust government, they were accepting of measures and messages as presented through government channels, pointing to the importance of (re)building trust in government. Perhaps more importantly however, data indicate that resources should be invested in monitoring and evaluating public perception of individuals and institutions generating the evidence-base used to guide government communication and decision-making to ensure trust is maintained. Theoretically, our work adds to our understanding of the nature of trust as it relates to the association between interpersonal and institutional trust, and also the nature of trust across institutions.

Acceptability of an Online Module Addressing Weight Bias: Perspectives and Attitudes of Undergraduate Health Students and Instructors.

Weight bias and discrimination are highly pervasive and harmful to Canadians with higher weights. Researchers and practitioners who deliver, evaluate, and advise on dietary and weight-related interventions may inadvertently perpetuate weight bias through their work; however, trainees in these fields rarely have access to weight bias education within their applied health programs. This study evaluated the acceptability of an online educational weight bias module developed for undergraduate students enrolled in health courses. The intervention included a pre-recorded 20-minute online module with prompts for reflection or discussion, a self-assessment quiz, as well as a separate module and range of resources for instructors. Overall, 211 students from applied health courses and 4 instructors completed an online survey querying the module's delivery, impact, and relevance. Students agreed that the module provided useful information (82%), was easy to understand (97%), and was the right length (75%), but reported wanting more interactivity and engagement with the content. Instructors found the module engaging and useful and expressed interest in additional resources and support for weight bias education. Future research should explore the impact of weight bias education on students' weight-related attitudes and perceptions as well as feasibility and relevance of online features such as multimedia tools.

Examining if changes in gender-specific and co-ed intramural programs affect youth physical activity over time: a natural experiment evaluation using school- and student-level data from the COMPASS study.

BACKGROUND: Despite the benefits of physical activity (PA), the majority of Canadian youth are falling short of the recommended 60 min of moderate-to-vigorous physical activity (MVPA) per day. School-based physical activity programs such as intramurals, are important opportunities for youth to be physically active. There is limited evidence available on the impact of gender-specific (e.g., female-only, male-only) and co-ed intramurals on youth PA over time, however, evidence suggests female-only intramurals may be important for female MVPA. This research aims to capitalize on a natural experiment to generate practice-based evidence on the impact of changes in gender-specific and co-ed intramurals on youth MVPA over time. METHODS: This study used linked longitudinal school- and student-level data from Ontario secondary schools in year 5 (Y5:2016-2017), year 6 (Y6: 2017-2018) and year 7 (Y7: 2018-2019) of the COMPASS study. Data on intramurals from 55 schools were used to determine the changes to gender-specific and co-ed intramurals that occurred from Y5 to Y6. Baseline demographic characteristics were measured and data on PA and sport participation were collected in Y5, Y6 and Y7 on a sample of 4417 students. Hierarchical linear mixed regression models were used to estimate how changes in gender-specific and co-ed intramurals were associated with youth MVPA over time. RESULTS: Participation in intramural, varsity and community sport were all positively and significantly associated with youth MVPA. Changes in gender-specific and co-ed intramurals were not significantly associated with youth MVPA in Y6 or Y7. However, the positive association between maintaining the addition of gender-specific intramurals on female MVPA in Y7 was on par with the significance level of α = 0.05, suggesting that adding gender-specific intramurals may be important for female MVPA. CONCLUSIONS: Adding gender-specific and co-ed intramurals may not be sufficient strategies to increase PA among youth. Further research should explore the effect of gender-specific intramurals on youth PA, as this study may have been underpowered at the school-level. Gender-specific intramurals may promote a supportive PA environment that promotes MVPA, especially among females. These intramurals may be an important component of more comprehensive strategies to increase youth MVPA.

A quasi-experimental examination of how changes in school-level intramurals are associated with physical activity among a sample of Canadian secondary school students from the COMPASS study.

INTRODUCTION: Intramurals in schools may encourage physical activity among youth. Schools are continuously making changes to these intramurals, yet it is not well understood how these changes impact youth physical activity. The main objective of this research was to examine if changes in the number of intramurals were associated with youth physical activity over time with a secondary objective to explore the association between sport participation and physical activity among youth over time. METHODS: This study used three years of linked longitudinal school- and student-level data from Ontario schools in year 5 (Y5: 2016-2017), year 6 (Y6: 2017-2018) and year 7 (Y7: 2018-2019) of the COMPASS study. Data on intramurals from 55 schools were collected from the School Programs and Policies questionnaire to determine intramural changes that were made from Y5 to Y6. Using the COMPASS Student Questionnaire, baseline demographics were collected and data on physical activity and sport participation were measured at Y5, Y6 and Y7 on 4417 students. Hierarchical linear mixed regression models were used to estimate how changes in intramurals were associated with youth physical activity over time. RESULTS: Changes in school-specific intramurals were not significantly associated with physical activity over time. Intramural, varsity and community sport participation were all positively and significantly associated with youth physical activity among female and males. CONCLUSIONS: Intramural, varsity and community sport participation are important opportunities for youth physical activity. Schools should offer a variety of intramural and varsity sports to encourage physical activity. Although adding intramurals may not be effective at increasing youth physical activity, they may be effective when used in combination with other strategies to increase physical activity.

High School Intramural Participation and Substance Use: A Longitudinal Analysis of COMPASS Data.

BACKGROUND: There is an association between sports participation and substance use. However, there is some evidence that intramural sports in high school may not have the same effect. Therefore, the objective of this research was to examine the longitudinal associations between intramural participation in high school and substance use. Methods: This study used a three-year linked sample (2016-2018) of grade 9 and 10 (ages 13-17) Canadian high school students in the COMPASS (Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, Sedentary behavior) study (n = 7,845). Students reported their participation in intramurals over time (consistent, none, initiate, intermittent, and quit) and their substance use behaviors (binge drinking, cannabis use, cigarette use, and e-cigarette use). Mixed effects models were used. Results: 42% of students did not participate in intramurals. For binge drinking, male students who never participated had lower odds (0.66 [0.47-0.93]) compared to consistent intramural participators. Female (3.50 [CI: 1.34-9.16]) and male students (1.97 [1.28-3.02]) who did not participate in any intramurals were more likely to use cannabis than consistent participators. Male students who did not participate were also more likely to use cigarettes (1.81 [1.05-3.12]). No associations were found between intramural participation and e-cigarette use. Conclusion: Intramural participation may be associated with increased binge drinking among male high school students. More promisingly, consistent participation in intramurals may be protective against cannabis use among male and female students and cigarette use among male students.

Evaluating the Impact of the Healthy Kids Community Challenge (HKCC) on Physical Activity of Older Youth.

(1) Background: The Healthy Kids Community Challenge (HKCC) was a community-based obesity prevention intervention funded by the Government of Ontario (Canada). (2) Methods: A quasi-experimental design was used to examine the impact of the HKCC on physical activity (PA) outcomes using both repeat cross-sectional (T1 2014-2015, n = 31,548; T2 2015-2016, n = 31,457; and T3 2016-2017, n = 30,454) and longitudinal data (n = 3906) from the COMPASS study. Grade 9-12 students in HKCC communities were placed into one of three intervention groups [T2 data collection post-HKCC finishing (IG1), T2 data collection during HKCC (IG2), and T2 data collection pre-HKCC starting (IG3)], Ontario students in non-HKCC communities were Control Group 1 (CG1) and Alberta students were Control Group 2 (CG2). (3) Results: Repeat cross-sectional results show over time the HKCC had no significant impact on PA outcomes in any of the intervention groups. Longitudinal results show a significant decrease in time spent in moderate-to-vigorous PA (IG2: -3.15 min/day) between T1 and T3 in IG2. (4) Conclusions: These results suggest the HKCC did not have an impact on improving PA outcomes among older youth in HKCC communities. Moving forward, there is a need to provide effective and sustainable interventions to promote PA among older youth.

Examining If Changes in the Type of School-Based Intramural Programs Affect Youth Physical Activity over Time: A Natural Experiment Evaluation.

(1) School-based physical activity programs such as intramurals provide youth with inclusive opportunities to be physically active, yet we know little about how types of intramurals (e.g., team and individual sports) may contribute to youth MVPA. This research aims to evaluate how real-world changes in types of intramurals available in schools impact youth physical activity over time. (2) This study used three years of longitudinal school- and student-level data from Ontario schools participating in year 5 (2016-2017), year 6 (2017-2018) and year 7 (2018-2019) of the COMPASS study. Data on types of intramural programs from 55 schools were obtained, baseline demographic characteristics were measured and data on physical activity and sport participation were collected on a sample of 4417 students. Hierarchical linear mixed regression models were used to estimate how changes in the type of intramurals associate with youth MVPA over time. (3) Regardless of participation, adding individual and team intramurals was significantly and positively associated with female MVPA in Y6. (4) The indirect, but positive relationship between adding individual and team intramurals and female MVPA may be explained by other characteristics of the school environment that are conducive to female MVPA.

A School-Level Examination of the Association between Programs and Policies and Physical Activity Outcomes among Females from the COMPASS Study.

(1) The majority of Canadian youth are not meeting physical activity guidelines, and more female than male youth are falling short of these recommendations. School programs and policies are a viable strategy to improve youth physical activity. However, they may differentially affect female and male activity. This study aimed to examine school-level differences in physical activity outcomes among male and female students and to explore how school programs and policies associate with school-level physical activity outcomes among females. (2) This study used data from 136 schools participating in year 7 (Y7 2018-2019) of the COMPASS study. Data on school programs and policies and on student physical activity were collected. School-level means and percentages for outcomes were calculated and compared between males and females and the impact of physical activity programs and policies on female physical activity outcomes were examined. (3) More males met the guidelines, achieved more strength training days and physical activity minutes compared to females. The number of female varsity sports, community partnerships and fitness ambassadors were all positively and significantly associated with female physical activity. (4) Supportive physical activity environments fostered by offering varsity sports, establishing community partnerships and positive role models may promote physical activity among female youth.

High school sport participation and substance use: A cross-sectional analysis of students from the COMPASS study.

INTRODUCTION: The objective of this study was to examine the association between participation in school sports and substance use behaviors in both male and female high school students. METHODS: The current study used cross-sectional data from 60,601 students from Year 6 (2017-2018) of the COMPASS study. Students reported their school physical activity participation (none, intramurals only, varsity only, both) and past 30-day substance use (binge drinking, cannabis use, cigarette use, e-cigarette use). Hierarchical logistic regression models predicted the odds of substance use, by sex. RESULTS: 55% of students did not participate in any school sports and 32% reported substance use. Intramurals were negatively associated with cannabis use and cigarette use among all students and e-cigarette use among females. Varsity sports were associated with lower odds of cigarette use among all students and cannabis use among males. In contrast, participating in varsity sports was associated with increased odds of binge drinking and e-cigarette use among all students. Participating in both intramurals and varsity sports was associated with increased odds of binge drinking and e-cigarette use but with decreased odds of cannabis use and cigarette use. CONCLUSIONS: Intramurals were found to be protective against cannabis use and cigarette use among all students and e-cigarette use among females. Although varsity sports were protective against cannabis and cigarette use, they were found to be a risk factor for binge drinking and e-cigarette use. Substance use prevention efforts should be a focus among school varsity sports teams, especially for binge drinking and e-cigarette use.

A cross-sectional examination of the association between co-ed and gender-specific school intramural programs and intramural participation among a sample of Canadian secondary school students.

Intramurals are an important part of the physical activity offerings in secondary schools; however, it is not well understood how co-ed and gender-specific intramural programs impact intramural participation among male and female students. Therefore, the objective of this research was to examine if the number of co-ed, male-only, and female-only intramurals offered at a school was associated with student participation in intramurals. A large sample of Canadian secondary school students (N = 59,370) completed the COMPASS survey in 2017-2018. School staff reported the number of co-ed, male-only, and female-only intramurals offered at each school. Students reported whether they participated in school intramurals. Hierarchical models were used to assess associations. Intramural participation was marginally higher among male students (36%) than female students (32%; p < 0.0001). Female students attending schools that offered female-only intramurals were 17% (OR 1.17 [95% CI: 1.05-1.30]) more likely to participate. The number of co-ed and male-only intramurals offered were not significantly associated with student participation. We found a positive association between offering female-only intramurals and female intramural participation, highlighting the importance of these programs for female students. Offering female-only intramurals may be a way for schools to improve participation and physical activity levels of female students. More research is needed on the impact of specific sports or activities on male and female student participation.

Qualitative Pilot Study of Veterinarians' Perceptions of and Experiences with Counseling about Dog Walking in Companion-Animal Practice in Southern Ontario.

Dog walking is beneficial to dogs and their owners, and it supports One Health, an initiative devoted to improving the health of animals and humans. Despite the benefits of dog walking, many dogs and their owners are not engaging in adequate dog-walking exercise. One way to encourage dog walking is for veterinarians to counsel owners on dog walking during veterinary appointments. This pilot study used individual in-person or telephone interviews to understand veterinarians' perceptions of and experiences with counseling about dog walking in companion animal practice. Seventeen veterinarians licensed to provide canine care in Ontario participated in an interview in 2015. Thematic analysis was used to analyze the interview transcripts. Participants thought dog walking was important for both dogs and owners and discussed physical, social, and mental benefits of dog walking. Participants described barriers to dog-walking counseling including dog owners' lack of compliance or physical condition, dogs' behavior, and lack of time or low priority during appointments. Also, participants discussed how dog walking was not addressed in their professional veterinary education. These findings can be used to educate veterinary students and practicing veterinarians on the value of dog walking for people and dogs and the barriers they may face when counseling clients about dog walking.