Applying Implementation Science to Identify Primary Care Providers' Enablers and Barriers to Using Survivorship Care Plans.

Primary care providers (PCPs) have been given the responsibility of managing the follow-up care of low-risk cancer survivors after they are discharged from the oncology center. Survivorship Care Plans (SCPs) were developed to facilitate this transition, but research indicates inconsistencies in how they are implemented. A detailed examination of enablers and barriers that influence their use by PCPs is needed to understand how to improve SCPs and ultimately facilitate cancer survivors' transition to primary care. An interview guide was developed based on the second version of the Theoretical Domains Framework (TDF-2). PCPs participated in semi-structured interviews. Qualitative content analysis was used to develop a codebook to code text into each of the 14 TDF-2 domains. Thematic analysis was also used to generate themes and subthemes. Thirteen PCPs completed the interview and identified the following barriers to SCP use: unfamiliarity with the side effects of cancer treatment (Knowledge), lack of clarity on the roles of different healthcare professionals (Social Professional Role and Identity), follow-up tasks being outside of scope of practice (Social Professional Role and Identity), increased workload, lack of options for psychosocial support for survivors, managing different electronic medical records systems, logistical issues with liaising with oncology (Environmental Context and Resources), and patient factors (Social Influences). PCPs value the information provided in SCPs and found the follow-up guidance provided to be most helpful. However, SCP use could be improved through streamlining methods of communication and collaboration between oncology centres and community-based primary care settings.

From struggle to strength in African and Middle Eastern newcomers' integration stories to Canada: A participatory health equity research study.

BACKGROUND AND OBJECTIVES: Newcomers (immigrants, refugees, and international students) face many personal, gender, cultural, environmental and health system barriers when integrating into a new society. These struggles can affect their health and social care, reducing access to mental health care. This study explores the lived experiences of African and Middle Eastern newcomers to Ontario, Canada. An understanding of newcomer integration challenges, successes and social justice issues is needed to improve health equity and social services. METHODS: In this qualitative study, we used a participatory research approach to collect stories reflecting participants' integration perspectives and experiences. Beginning with our immigrant community network, we used snowball sampling to recruit newcomers, ages 18 to 30, originating from Africa or the Middle East. We used qualitative narrative analysis to interpret stories, identifying context themes, integrating related barriers and facilitators, and resolutions and learnings. We shared our findings and sought final feedback from our participants. FINDINGS: A total of 18 newcomers, 78% female and approximately half post-secondary students, participated in the study. Participants described an unknown and intimidating migration context, with periods of loneliness and isolation aggravated by cold winter conditions and unfamiliar language and culture. Amidst the struggles, the support of friends and family, along with engaging in schoolwork, exploring new learning opportunities, and participating in community services, all facilitated integration and forged new resilience. CONCLUSIONS: Community building, friendships, and local services emerged as key elements for future immigrant service research. Utilizing a participatory health research approach allowed us to respond to the call for social justice-oriented research that helps to generate scientific knowledge for promoting culturally adaptive health care and access for marginalized populations.

COVID-19 vaccine uptake, conspiracy theories, and health literacy among Black individuals in Canada: Racial discrimination, confidence in health, and COVID-19 stress as mediators.

Factors influencing vaccine uptake in Black individuals remain insufficiently documented. Understanding the role of COVID-19 related stress, conspiracy theories, health literacy, racial discrimination experiences, and confidence in health authorities can inform programs to increase vaccination coverage. We sought to analyze these factors and vaccine uptake among Black individuals in Canada. A representative sample of 2002 Black individuals from Ontario, Quebec, Alberta, Nova Scotia, New Brunswick, British Columbia, and Manitoba, aged 14 years or older completed questionnaires assessing vaccine uptake, health literacy, conspiracy theories, racial discrimination experiences, COVID-19-related stress, and confidence in health authorities. Mediation analyses were conducted to assess (1) the effect of health literacy on COVID-19 vaccination uptake through confidence and need, COVID-19 related traumatic stress, and racial discrimination, and (2) the effect of conspiracy beliefs on COVID-19 vaccination uptake through the same factors. Overall, 69.57% (95% confidence interval, 67.55%-71.59%) of the participants were vaccinated and 83.48% of them received two or more doses. Those aged 55 years and older were less likely to be vaccinated, as well as those residing in British Columbia and Manitoba. Mediation models showed that the association between health literacy and COVID-19 vaccine uptake was mediated by confidence in health authorities (B = 0.02, p < 0.001), COVID-19-related stress (B = -0.02, p < 0.001), and racial discrimination (B = -0.01, p = 0.032), but both direct and total effects were nonsignificant. Lastly, conspiracy beliefs were found to have a partial mediation effect through the same mediators (B = 0.02, p < 0.001, B = -0.02, p < 0.001, B = -0.01, p = 0.011, respectively). These findings highlight the need for targeted interventions to address vaccine hesitancy and inform approaches to improve access to vaccinations among Black communities.

Antiracist training programs for mental health professionals: A scoping review.

Racism has been shown to be directly deleterious to the mental health care received by minoritized peoples. In response, some mental health institutions have pledged to provide antiracist mental health care, which includes training mental health care professionals in this approach. This scoping review aimed to synthesize the existing published material on antiracist training programs among mental health care professionals. To identify studies, a comprehensive search strategy was developed and executed by a research librarian in October 2022 across seven databases (APA PsycInfo, Education Source, Embase, ERIC, MEDLINE, CINAHL, and Web of Science). Subject headings and keywords relating to antiracist training as well as to mental health professionals were used and combined. There were 7186 studies generated by the initial search and 377 by the update search, 30 were retained and included. Findings revealed four main antiracist competencies to develop in mental health professionals: importance of understanding the cultural, social, and historical context at the root of the mental health problems; developing awareness of individual biases, self-identity and privilege; recognizing oppressive and racism-sustaining behaviors in mental health care settings; and, employing antiracist competencies in therapy. Professionals who have taken trainings having the main components have developed skills on the interconnectedness between racialized groups' mental health and the cultural, religious, social, historical, economic, and political issues surrounding race, necessary for successful clinical practice and for providing anti-racist mental health care. This scoping review presents a summary of the essential antiracist competencies drawn from the literature which must be applied in a mental health care setting, to improve help seeking behaviors, and reduce distrust in mental health care professionals and settings.

Examining the disparities: A cross-sectional study of socio-economic factors and food insecurity in Togo.

BACKGROUND: Despite many interventions, Togo continues to have one of the highest rates of poverty and food insecurity in the sub-Saharan African region. Currently there is no systematic analysis of the factors associated with household food-insecurity in this country. This study aimed at exploring the factors associated with food insecurity in Togo. METHODS: This was a cross-sectional study that used data from five waves (2014 to 2018) of the Gallup World Poll (GWP) for Togo. Sample size included 4754 participants, aged 15 and above. Food insecurity was measured using the Food Insecurity Experience Scale (FIES) questionnaire as per the Food and Agricultural Organization (FAO) guidelines. Our outcome variable was food insecurity, categorized as: 1) food secure (FIES score = 0-3), moderately food insecure (FIES score = 4-6), and severely food insecure (FIES score = 7-8). We did descriptive and multinomial regressions to analyze data using Stata version 16. RESULTS: Between 2014 and 2018, the percentage of severe food insecurity fluctuated-42.81% in 2014, 37.79% in 2015, 38.98% in 2016, 45.41% in 2017, and 33.84% in 2018. Whereas that of moderate food insecurity increased from 23.55% to 27.33% except for 2016 and 2017 where the percentage increased to 32.33% and 27.46% respectively. In the logistic regression analysis, we found that respondents with lower than elementary education had a higher relative risk ratio of moderate (RRR = 1.45,95%CI = 1.22-1.72) and severe (RRR = 1.72, 95%CI = 1.46-2.02) food insecurity compared to those with secondary and higher education. Rural respondents had higher RRR of severe food insecurity (RRR = 1.37, 95%CI = 1.16-1.62) compared to those who lived in the urban areas. Compared with those in the richest wealth quintile, respondents in the poorest wealth quintile had 2.21 times higher RRR of moderate (RRR = 2.21, 95%CI = 1.69-2.87) and 3.58 times higher RRR of severe (RRR = 3.58, 95%CI = 2.81-4.55) food insecurity. CONCLUSION: About two-thirds of participants experienced some level of food insecurity in 2018. Lower levels of education, rural residency and poorer household wealth index areas were associated with a higher risk of food insecurity. National food security programs should focus on promoting education and improving socioeconomic condition of people especially in rural areas.

Socio-economic and cultural factors associated with the utilization of maternal healthcare services in Togo: a cross-sectional study.

BACKGROUND: Proper utilization of maternal healthcare services plays a major role on pregnancy and birth outcomes. In sub-Saharan Africa, maternal and child mortality remains a major public health concern, especially in least developed countries such as Togo. In this study, we aimed to analyze factors associated with use of maternal health services among Togolese women aged 15-49 years. METHODS: This study used data from third round of nationally representative Demographic and Health Survey conducted in Togo in 2013. Analysis included 4,631 women aged 15-49 years. Outcome variables were timely first antenatal care (ANC) visits, adequate ANC4 + visits, and health facility delivery. Data were analyzed using Stata version 16. RESULTS: Overall, proportion of maternal healthcare utilization was 27.53% for timely first ANC visits, 59.99% for adequate ANC visits, and 75.66% for health facility delivery. Our multivariable analysis showed significant differences among women in highest wealth quintile, especially in rural areas with increasing odds of timely first ANC visits (Odds ratio (OR) = 3.46, 95% CI = 2.32,5.16), attending adequate ANC visits (OR = 2.19, 95% CI = 1.48,3.24), and delivering in health facilities (OR = 8.53, 95% CI = 4.06, 17.92) compared to those in the poorest quintile. Also, women with higher education had increased odds of timely first ANC visits (OR = 1.37, 95% CI = 1.11,1.69), and attending adequate ANC visits (OR = 1.73, 95% CI = 1.42,2.12) compared to those with no formal education. However, having higher parity and indigenous beliefs especially in rural areas decreased odds of using healthcare services. CONCLUSIONS: Findings from this study showed that socio-economic inequality and socio-cultural barriers influenced the use of maternal healthcare services in Togo. There is therefore a need to improve accessibility and the utilization of maternal healthcare services through women's economic empowerment and education to reduce the barriers.

Utilization of healthcare services by women of childbearing age has been shown to reduce maternal and child mortality. However, in sub-Saharan Africa, maternal and child mortality remains a major public health issue. This is especially the case in Togo, one of the smallest countries in West Africa. The objective of this study was to assess the factors associated with utilization of maternal healthcare services among Togolese women aged 15­49 years. This was a cross-sectional study that used data from the Togo 2013 Demographic and Health Survey, a nationally representative household survey of women of childbearing age in Togo. Findings from the current study showed that the overall proportion of maternal healthcare utilization was 27.53% for timely first antenatal care visits, 59.99% for adequate antenatal care visits, and 75.66% for health facility delivery. Also, this study found that socio-economic inequality and socio-cultural barriers influenced the use of maternal healthcare services in Togo. For instance, women in the highest wealth quintile, those with higher education, and those who were covered by health insurance had higher odds of utilizing maternal healthcare service. Whereas, women who had indigenous beliefs, those from other ethnicities, who lived in the Savanes and Plateaux regions, as well as those with higher parity had lower odds of using maternal healthcare services. The results indicate that there is an urgent need to promote women's economic empowerment and education to improve accessibility and the utilization of maternal healthcare services.

Relationship satisfaction and psychological wellbeing in men having participated in the MindTheHeart® psychoeducation intervention after an acute coronary syndrome.

This study investigated the associations of relationship satisfaction, depression, and anxiety post-acute coronary syndrome in a sample of men having completed an early, couple-focused, and men-tailored psychoeducation intervention. A baseline sample of 50 male patients were followed over a 12-month period and completed the Couples Satisfaction Index and the Depression, Anxiety and Stress Scale. Results revealed a significant improvement in depression symptoms from T0 to T1, during which all participants completed the MindTheHeart® psychoeducation intervention. In addition, a hierarchical regression analysis showed that relationship satisfaction is an important predictor of this improvement in depression symptoms. Our preliminary findings point to the consideration of life partners in post-ACS interventions and encourage the exploration of this clinical approach in future research.

Comparing Adherence with Best Practices in End-of-Life Care After Implementing the End-of-Life Order Set: A Quality Improvement Project in an Ottawa Academic Hospital.

Background: Physicians in acute care require tools to assist them in transitioning patients from a "life prolonging" approach to "end-of-life care," and standardized order sets can be a useful strategy. The end-of-life order set (EOLOS) was developed and implemented in the medical wards of a community academic hospital. Objective: To compare adherence with best practices in end-of-life care after implementing the EOLOS. Methods: We conducted a retrospective chart review of admitted patients with expected deaths in the year preceding EOLOS implementation ("before EOLOS" group), and in the 12 to 24 months following EOLOS implementation ("after EOLOS" group). Results: A total of 295 charts were included: 139 (47%) in the "before EOLOS" group and 156 (53%) in the "after EOLOS" group, of which 117/156 charts (75%) had a completed EOLOS. The "after EOLOS" group demonstrated more "do not resuscitate" orders and more written communication to team members about comfort goals of care. There was a decrease in nonbeneficial interventions in the last 24 hours of life in the "after EOLOS" group: high-flow oxygen, intravenous antibiotics, and deep vein thrombosis/venous thromboembolism prophylaxis. The "after EOLOS" group demonstrated increased prescription of all common end-of-life medications, except for opioids, which had a high preexisting rate of prescription. Patients in the "after EOLOS" group showed a higher rate of spiritual care and palliative care consult team consultation. Conclusion: Findings support standardized order sets as a good framework allowing generalist hospital staff to improve adherence to established palliative care principles and improve end-of-life care of hospital inpatients.

Prevalence and factors related to COVID-19 vaccine hesitancy and unwillingness in Canada: A systematic review and meta-analysis.

This systematic review and meta-analysis examined the prevalence and factors associated with vaccine hesitancy and vaccine unwillingness in Canada. Eleven databases were searched in March 2022. The pooled prevalence of coronavirus disease 2019 (COVID-19) vaccine hesitancy and unwillingness was estimated. Subgroup analyses and meta-regressions were performed. Out of 667 studies screened, 86 full-text articles were reviewed, and 30 were included in the systematic review. Twenty-four articles were included in the meta-analysis; 12 for the pooled prevalence of vaccine hesitancy (42.3% [95% CI, 33.7%-51.0%]) and 12 for vaccine unwillingness (20.1% [95% CI, 15.2%-24.9%]). Vaccine hesitancy was higher in females (18.3% [95% CI, 12.4%-24.2%]) than males (13.9% [95% CI, 9.0%-18.8%]), and in rural (16.3% [95% CI, 12.9%-19.7%]) versus urban areas (14.1% [95%CI, 9.9%-18.3%]). Vaccine unwillingness was higher in females (19.9% [95% CI, 11.0%-24.8%]) compared with males (13.6% [95% CI, 8.0%-19.2%]), non-White individuals (21.7% [95% CI, 16.2%-27.3%]) than White individuals (14.8% [95% CI, 11.0%-18.5%]), and secondary or less (24.2% [95% CI, 18.8%-29.6%]) versus postsecondary education (15.9% [95% CI, 11.6%-20.2%]). Factors related to racial disparities, gender, education level, and age are discussed.

The Feasibility of a Primary Care Based Navigation Service to Support Access to Health and Social Resources: The Access to Resources in the Community (ARC) Model.

Introduction: We established a patient centric navigation model embedded in primary care (PC) to support access to the broad range of health and social resources; the Access to Resources in the Community (ARC) model. Methods: We evaluated the feasibility of ARC using the rapid cycle evaluations of the intervention processes, patient and PC provider surveys, and navigator log data. PC providers enrolled were asked to refer patients in whom they identified a health and/or social need to the ARC navigator. Results: Participants: 26 family physicians in four practices, and 82 of the 131 patients they referred. ARC was easily integrated in PC practices and was especially valued in the non-interprofessional practices. Patient overall satisfaction was very high (89%). Sixty patients completed the post-intervention surveys, and 33 reported accessing one or more service(s). Conclusion: The ARC Model is an innovative approach to reach and support a broad range of patients access needed resources. The Model is feasible and acceptable to PC providers and patients, and has demonstrated potential for improving patients' access to health and social resources. This study has informed a pragmatic randomized controlled trial to evaluate the ARC navigation to an existing web and telephone navigation service (Ontario 211).

A Systematic Review on Vaccine Hesitancy in Black Communities in Canada: Critical Issues and Research Failures.

Black communities have been disproportionately impacted by Coronavirus Disease 2019 (COVID-19) in Canada, in terms of both number of infections and mortality rates. Yet, according to early studies, vaccine hesitancy appears to be higher in Black communities. The purpose of this systematic review is to examine the prevalence and factors associated with vaccine hesitancy in Black communities in Canada. Peer-reviewed studies published from 11 March 2020 to 26 July 2022, were searched through eleven databases: APA PsycInfo (Ovid), Cairn.info, Canadian Business & Current Affairs (ProQuest), CPI.Q (Gale OneFile), Cochrane CENTRAL (Ovid), Embase (Ovid), Érudit, Global Health (EBSCOhost), MEDLINE (Ovid), and Web of Science (Clarivate). Eligible studies were published in French or English and had empirical data on the prevalence or factors associated with vaccine hesitancy in samples or subsamples of Black people. Only five studies contained empirical data on vaccine hesitancy in Black individuals and were eligible for inclusion in this systematic review. Black individuals represented 1.18% (n = 247) of all included study samples (n = 20,919). Two of the five studies found that Black individuals were more hesitant to be vaccinated against COVID-19 compared to White individuals, whereas the other three found no significant differences. The studies failed to provide any evidence of factors associated with vaccine hesitancy in Black communities. Despite national concerns about vaccine hesitancy in Black communities, a color-blind approach is still predominant in Canadian health research. Of about 40 studies containing empirical data on vaccine hesitancy in Canada, only five contained data on Black communities. None analyzed factors associated with vaccine hesitancy in Black communities. Policies and strategies to strengthen health research in Black communities and eliminate the color-blind approach are discussed.

Canadian French Translation and Preliminary Validation of the Conformity to Masculine Norms Inventory: A Pilot Study.

Conformity to masculine norms has been linked to poor mental and physical health outcomes. Its valid assessment among subgroups of the population is therefore a crucial step in the investigation of intercultural variability in the enactment of masculinity, as well as its causes, costs, and benefits. The present pilot study aimed to adapt and conduct a preliminary validation of a French version of the Conformity to Masculine Norms Inventory (CMNI-22), a self-report questionnaire designed to assess overall conformity to male gender standards. The French adaptation of the CMNI-22 (CanFr-CMNI-22) was developed using a forward-backward translation process. The data from a sample of 57 Canadian French men (23-81 years old), collected at two time points 2 weeks apart, were then analyzed to investigate the psychometric properties and factor structure of the CanFr-CMNI-22. Findings indicated adequate internal reliability of the global scores and highly satisfactory test-retest reliability. Correlations with the Male Role Norms Inventory-Short Form (MRNI-SF) at both time points also showed strong convergent validity. Overall, the CanFr-CMNI-22 appears to be a reliable and valid instrument to assess conformity to traditional masculine gender norms in French-speaking men from the general population. This study is a key step in a research process aiming to validate the Canadian French version of the CMNI and contributes to enhance inclusive research and clinical care to foster men's health.

Review of Referrals Sent to the Emergency Department for Management of Hypertension.

BACKGROUND: Hypertensive urgencies, unlike hypertensive emergencies, are severe episodes of hypertension without evidence of end-organ damage. Most recent guidelines advise against referring patients with hypertensive urgencies to the emergency department (ED) for treatment. There is a lack of Canadian data surrounding whether referrals to the ED regarding hypertension are appropriate. We analyzed referrals to the Montfort Hospital ED due to hypertension and assessed if they met the criteria for hypertensive emergencies. METHODS: This was a retrospective chart study of all ED visits at Montfort Hospital from the 2016 fiscal year with a final diagnosis/chief complaint of hypertension. Charts were assessed to determine if these patients met the criteria for having true hypertensive emergencies. RESULTS: Out of the 54,000 visits to the Montfort ED, 254 reported hypertension as a final diagnosis/chief complaint. Of those, 67 patients had been referred by a healthcare practitioner, while 187 were self-referred. None of the referred patients met the criteria for hypertensive emergency; however, eight of these patients did have symptoms indicating a possibility of hypertensive emergency. Six of the self-referred patients met criteria for hypertensive emergency. The majority (71.6%) of patients referred did not require on-site antihypertensive treatment, and 37.3% of patients were sent home with new outpatient prescriptions. CONCLUSION: All the cases referred to the Montfort ED for hypertension were considered hypertensive urgencies and none of them required ED hypertensive treatment. Further investigation is required to help optimize appropriate patient referral to the ED for true hypertensive emergencies and improve management of hypertensive urgencies in the community.

Commentary: Time to Improve Access to Psychotherapies - A Family Medicine Perspective.

The COVID pandemic - despite the dire economic and personal toll on all Canadians - is helping us move forward. It bears light on the most vulnerable. Indeed, it has aggravated the mental health of those with such disorders as anxiety or depression and revealed the precarity of our mental well-being. The health system, and most particularly our primary care system, is overwhelmed and its capacity to answer to the mental healthcare of Canadians is put to the test. It is, therefore, time for family physicians to be able to find support in various ways and means to answer the needs of their patients. This support may be through public coverage to psychotherapies, which has been proven effective in Australia and the UK since the last decade, or open access to various validated web-based tools offering cognitive behavioural therapies for the most common mental health disorders in both official languages.

Prevalence of Symptoms of Anxiety Disorders and Depression in Cardiac Rehabilitation Patients in an Academic Hospital: a Case Study.

The relationship between body and mind is increasingly recognized in the occurrence and prognosis of cardiac disease. Based on reports detailing the potential (and the influence of certain risk factors) of developing depression and anxiety following cardiovascular disease, or a cardiac event, most notably acute coronary syndrome (ACS), we investigated whether such symptoms also existed in patient cases found at the cardiac rehabilitation unit of an academic hospital of Eastern Ontario. We examined data from charts during a 6-year period (2012-2017). The Hospital Anxiety and Depression Scale cumulated data within a retrospective cross-sectional study, was used to estimate the prevalence of anxious and depressive symptoms that might reflect the presence of psychological distress. Overall, our sample included 1178 patient files, 81.3% of which were diagnosed with ACS and 69.6% were male. 63.1% of the patients were between 60 and 79 years old at the time of diagnosis. Most patients were Caucasian (81.1%), married (60.3%), and living with their family (74.3%), and 49.7% were recorded as overweight or obese. We found that 29.3% of patients reported symptoms of psychological distress. Regression analyses revealed strong negative correlations between the proportion of symptoms of psychological distress and factors like age and functional capacity as measured by metabolic equivalents. Significant associations were also established between symptoms of psychological distress and factors such as obesity, sedentary lifestyle, smoking, and sex (female). This study was undertaken as part of a business case to implement a new cardiac rehabilitation programme in an academic hospital of Eastern Ontario and illustrate to the managers and decision-makers, the important factors to consider and to target when developing a stepped-care program for patients in cardiac rehabilitation in order to prevent psychological distress and how such a program was relevant to their institution.

Understanding men's psychological reactions and experience following a cardiac event: a qualitative study from the MindTheHeart project.

OBJECTIVES: Emotional issues such as depression, anxiety and post-traumatic stress disorder are common following a cardiac event. Despite their high prevalence, they often go undiagnosed and research suggests that men in particular are at higher risk. Therefore, a better understanding of men's experiences with a cardiac event and ensuing health services is key for adapting approaches that meet their needs. The aim of this study was to describe the self-reported emotional challenges that men face following a cardiac event and to understand their patterns of psychosocial adjustment. DESIGN: Qualitative study (focus groups and one-on-one interviews) using an interpretive phenomenal analysis. SETTING: Clinical settings (cardiac departments in hospitals, cardiac rehabilitation programme and family medicine clinics) and in the community in three Canadian provinces. PARTICIPANTS: A total of 93 men participated in the study through 22 focus groups and 5 semi-structured interviews, none has been excluded based on comorbidities. RESULTS: Four major themes emerged: (1) managing uncertainty and adversity; (2) distancing, normalising and accepting; (3) conformity to traditional masculine norms and (4) social, literacy and communication challenges. CONCLUSIONS: Healthcare professionals caring for men following a cardiac event must be aware of the psychological and social adjustments that accompany the physical challenges. However, there is a lack of explicit guidelines, tools and clinical training in men-sensitive approaches. Further research is required to better inform clinical practices and healthcare services.

Access to Resources in the Community Through Navigation: Protocol for a Mixed-Methods Feasibility Study.

BACKGROUND: Community-based health and social resources can help individuals with complex health and social needs achieve their health goals. However, there is often inadequate access to these resources due to a lack of physician and patient awareness of available resources and the presence of social barriers that limit an individual's ability to reach these services. Navigation services, where a person is tasked with helping connect patients to community resources, embedded within primary care may facilitate access and strengthen the continuity of care for patients. OBJECTIVE: This study aims to describe the protocol to assess whether the implementation of the Access to Resources in the Community (ARC) navigation model (an innovative approach to navigation services) is feasible, including its potential to achieve its intended outcomes, and to assess the viability of the evaluation approach. METHODS: The study consists of a single-arm, prospective, explanatory, mixed-methods, pre-post design feasibility study focusing on primary care practice settings with vulnerable populations. Participants include primary care providers and patients. RESULTS: Enrollment is closed with 82 patients. Navigation services have ended for 69 patients. CONCLUSIONS: The study of an innovative complex intervention requires an adequate assessment of the feasibility of the intended approach during which the potential challenges of the planned intervention and need for its adaptation may be uncovered. Undertaking a feasibility study of the ARC navigation model from a conceptually clear and methodologically solid protocol will inform on the practicality and acceptability of the approach, demand for the services, ease of implementation, quality of integration of the new services within primary care, and practicality and potential for efficacy prior to initiating a randomized controlled trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT03105635; https://clinicaltrials.gov/ct2/show/NCT03105635 (Archived by WebCite at hhttp://www.webcitation.org/75FrwXORl). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/11022.

Of Sound Heart and Mind: A Scoping Review of Risk and Protective Factors for Symptoms of Depression, Anxiety, and Posttraumatic Stress in People With Heart Disease.

BACKGROUND: Heart disease is related to the etiology of mental health problems such as depression, anxiety, and posttraumatic stress. OBJECTIVE: The goal of this scoping review was to determine which factors pose a significant risk for the onset of symptoms of depression, anxiety, and posttraumatic stress in patients with heart disease, as well as to identify what might protect them from these afflictions. METHOD: We conducted a thorough search of relevant medical and psychological databases (Scopus, PsycARTICLES, Psychology and Behavioral Sciences Collection, Sage Journals, and MEDLINE) and identified 41 studies that met inclusion criteria, which included all types of heart disease. RESULTS: The results of our review indicate that mental health history, the tendency to stifle negative emotional experiences (known as "type D personality"), and social support in patients with heart disease are related to the onset of or protection from depression, anxiety, and posttraumatic stress. These factors, along with gender and younger age, seem to be relatively consistent predictors of mental health problems in this population. CONCLUSIONS: As per our results, it is important for clinicians to attend to the mental health history, type D personality, and presence and quality of social support in patients with heart disease. More research into prevention and gender differences is necessary to hone the detection and treatment of these problems in people with heart disease. CLINICAL IMPLICATIONS: Attention to their mental health history, their ability to express and regulate affect, their age, and their gender will most likely assist in identifying symptoms of depression, anxiety, and posttraumatic stress in people with cardiac disease. Gender differences, particularly in the manifestation of depression, ought to be taken into account.

[Collaboration between Medicine and Psychology: Evolving Mentalities in Belgium and Evolution of the Health Care System in Canada]. / Collaboration médecine-psychologie : évolution des mentalités en Belgique et évolution du système de soins de santé au Canada.

Objectives 1) To give a portrait of the evolving mentalities prevailing in Belgium on the collaboration between psychologists and general practitioners, and identify the barriers to the development of the collaboration between those two health professionals 2) To report on the primary care reform in Canada, its role in fostering collaborative practice in primary mental health and on the strategies needed to improve collaboration.Methods Literature search using PubMed and Google Scholar.Results Because of the unmet need of psychologists in primary care, general practitioners and psychologists have a propensity to work together. However to facilitate the collaborative process there needs to be system changes and clear definition of scopes of practices. Both countries are at different levels of implementing change. In Belgium for example it is only very recently that the autonomous practice of clinical psychology has been acknowledged. In Canada although the primary care reform has put forward and supported collaborative care, focus on mental health is insufficient. Early reports on collaborative care in the new models of care inconsistently report improved health outcomes. Strategies to improve collaborative care are looking at teaching future health professionals on how to work together by integrating inter-professional education.Conclusion Both the health care system and graduate training need to support foster and teach collaborative care.

[Advocating for the Inclusion of Psychologists in Family Health Teams in Ontario, Canada]. / Plaidoyer pour l'inclusion de psychologues dans les équipes de santé familiale en Ontario, Canada.

Objectives This article advocates in favor of increasing the accessibility of psychological services in primary health care by focusing more specifically on the relevance of including psychologists in family health teams in primary care in Ontario.Methods The authors present their advocacy from two levels of information: 1) the main results of a demonstration project funded by the Primary Health Care Transition Fund (PHCTF) in which psychologists were integrated into family practices; and 2) experiences and general observations drawn from the combined experiences of the authors from the last decade regarding the inclusion of psychologists in primary care.Results Main results from the demonstration project: 1) highly prevalent mental illnesses (anxiety & mood disorders) are amenable to psychological interventions; 2) psychologists and family physicians are natural and complementary allies in primary care; 3) the cost of integrating psychologists to provide psychological interventions can be off-set by a reduction in physicians' mental health billing. Main observations drawn from authors' combined experiences in primary care: 1) relatively few psychologists work in family health teams in Ontario; 2) most non-pharmacological mental health interventions in primary care involve generic counselling, problem solving, educational groups, and linking to community resources; 3) lack of understanding of the difference between evidence-based psychological treatments and generic counselling; 4) many multidisciplinary clinics unfortunately benefit from only one type of non-medical mental health professional as part of their team to see all cases, independent of the level of complexity on the patient's side, and independent of the level of expertise or supervised training on the provider side; 5) multidisciplinary teams in primary care need various mental health professionals to cover for a wide range of presenting problems and levels of complexity/co-morbidities.Conclusion Our demonstration project combined with our continued clinical experience in primary care is consistent with the scientific literature on the topic of psychological services in primary care. Common mental health problems are highly prevalent. Societal costs are high. Accurate diagnosis is crucial. There are psychological treatments proven to work, and that are cost-effective. We can build on existing multidisciplinary teams and structures in place and also innovate by finding creative mechanisms linking the public and private sectors such as in the Australian primary care system. Interdisciplinary teams should integrate a judicious mix of pertinent skills with the right balance of varying levels of competencies to efficiently address varying levels of problem complexities and co-morbidities. At the moment, there is a gap to be filled in multidisciplinary primary care teams and psychologists are already extensively trained and available to fill this gap.