Exploration of how primary care models influence job satisfaction among primary care providers during the COVID-19 pandemic in New Brunswick: a descriptive and comparative study.

BACKGROUND: The COVID-19 pandemic has highlighted human resource gaps and physician shortages in healthcare systems in New Brunswick (NB), as evidenced by multiple healthcare service interruptions. In addition, the New Brunswick Health Council gathered data from citizens on the type of primary care models (i.e. physicians in solo practice, physicians in collaborative practice, and collaborative practice with physicians and nurse practitioners) they use as their usual place of care. To add to their survey's findings, our study aims to see how these different primary care models were associated with job satisfaction as reported by primary care providers. METHODS: In total, 120 primary care providers responded to an online survey about their primary care models and job satisfaction levels. We used IBM's "SPSS Statistics" software to run Chi-square and Fisher's exact tests to compare job satisfaction levels between variable groups to determine if there were statistically significant variations. RESULTS: Overall, 77% of participants declared being satisfied at work. The reported job satisfaction levels did not appear to be influenced by the primary care model. Participants reported similar job satisfaction levels regardless of if they practiced alone or in collaboration. Although 50% of primary care providers reported having symptoms of burnout and experienced a decline in job satisfaction during the COVID-19 pandemic, the primary care model was not associated with these experiences. Therefore, participants who reported burnout or a decline in job satisfaction were similar in all primary care models. Our study's results suggest that the autonomy to choose a preferred model was important, since 45.8% of participants reported choosing their primary care models, based on preference. Proximity to family and friends and balancing work and family emerged as critical factors that influence choosing a job and staying in that job. CONCLUSION: Primary care providers' staffing recruitment and retention strategies should include the factors reported as determinants in our study. Primary care models do not appear to influence job satisfaction levels, although having the autonomy to choose a preferred model was reported as highly important. Consequently, it may be counterproductive to impose specific primary care models if one aims to prioritize primary care providers' job satisfaction and wellness.

Effectiveness of a School-Based Culinary Programme on 9- and 10-Year-Old Children's Food Literacy and Vegetable, Fruit, and Breakfast Consumption.

School-based culinary courses may increase children's food literacy and improve their eating behaviours. This study assessed the impact of a school-based culinary programme on 9- and 10-year-old students' food literacy and vegetable, fruit, and breakfast consumption. This cluster quasi-experimental trial compared 88 grade 4 and 5 students who participated in the Apprenti en Action programme to 82 students who did not. Students' food literacy and eating behaviours were assessed with a self-administered questionnaire. The programme's impact on vegetable and fruit consumption, cooking skills, food skills, and food knowledge was measured using MANOVA, and the odds of eating breakfast at least five times per week were assessed with logistic regression. Students who participated in the programme reported a greater increase in their cooking skills (p = 0.013) and food knowledge (p = 0.028) than students in the control group. No effect was found on food skills and vegetables, fruit, and breakfast consumption (p-values > 0.05). Boys improved their cooking skills (p = 0.025) and food knowledge (p = 0.022), but girls did not. The programme improved students' cooking skills and food knowledge, especially among boys; however, modifications are needed to improve students' food skills and eating behaviours.

Accès aux soins primaires en temps opportun au Nouveau-Brunswick: Variabilité dans les régions de santé.

OBJECTIF: Examiner les facteurs qui influencent la variation de l'accès aux soins de santé primaires en temps opportun entre les différentes régions de santé du Nouveau-Brunswick. TYPE D'ÉTUDE: Étude descriptive et comparative des pratiques organisationnelles des cabinets de soins primaires selon leur rapidité d'accès. Les données ont été recueillies de décembre 2019 à mars 2020 à l'aide d'un questionnaire lors d'entretiens semi-dirigés menés par téléphone, en personne ou en ligne, selon la préférence des participants. CONTEXTE: Nouveau-Brunswick. PARTICIPANTS: Les participants à l'étude étaient des fournisseurs de soins primaires. Deux sortes de régions ont été ciblées : celles où la proportion d'habitants avec accès aux soins primaires en temps opportun est plus élevée (les régions avec accès plus rapide) et celles où cette proportion est plus faible (les régions avec accès plus lent). Un échantillon de 27 participants a été obtenu. PRINCIPAUX PARAMÈTRES À L'ÉTUDE: Les pratiques organisationnelles selon leur accessibilité en temps opportun (l'utilisation des nouvelles technologies, prestation des services de santé en équipe, la mesure du rendement des cabinets de médecine familiale, la programmation des rendez-vous et le mode de rémunération des médecins). RÉSULTATS: Les participants des régions avec accès plus rapide mesurent plus souvent leur rendement (45,5 % c. 12,5 %, p=,046), n'utilisent pas la rémunération mixte (0,0 % c. 31,3 %, p<,001) et ont un nombre plus élevé de patients à leur charge (moyenne de 2157 c. 950 patients, p=,025) contrairement aux participants des régions avec accès plus lent. CONCLUSION: Cette étude a permis de déterminer que la mesure du rendement et d'autres pratiques organisationnelles sont favorables à l'accès aux soins primaires en temps opportun.

Timely access to primary care in New Brunswick: Variability across health regions.

OBJECTIVE: To examine the factors that influence variation in timely access to primary care across the different health regions in New Brunswick. DESIGN: Descriptive and comparative study of organizational practices in primary care practices based on speed of access. Data were collected from December 2019 to March 2020 using semistructured interviews conducted by telephone, in person, or online, according to participants' preferences. SETTING: New Brunswick. PARTICIPANTS: Participants were primary care providers. Two types of regions were targeted: those with a higher proportion of citizens with timely access to primary care (regions with faster access) and those with less timely access (regions with slower access). A sample of 27 participants was used. MAIN OUTCOME MEASURES: Organizational practices (ie, new technologies, team-based health services, performance measurement, method of appointment booking, and physician remuneration model) according to prevalence of timely access. RESULTS: Participants in regions with faster access measured their performance more often (45.5% vs 12.5%, P=.046), did not use mixed compensation models (0.0% vs 31.3%, P<.001), and managed more patients (average of 2157 patients vs 950, P=.025), compared with participants from regions with slower access. CONCLUSION: This study found that performance measurements and other organizational practices are favourably linked to timely access to primary care.

A theory-based behavioural change communication intervention to decrease the provision of water to infants under 6 months of age in the Republic of Guinea.

OBJECTIVE: In many countries, the provision of water in the early months of a baby's life jeopardises exclusive breast-feeding (EBF). Using a behavioural theory, this study assessed the impact of a behaviour change intervention on mothers' intention to act and, in turn, on the water provision in addition to breast milk to their infants under 6 months of age (IU6M) in two regions of Guinea. DESIGN: A quasi-experimental design. Data on individual and environmental factors of the theoretical framework, sociodemographic and outcomes were collected using validated questionnaires before and after the intervention. The outcomes examined were the intention to provide water to IU6M, the provision of water and EBF. Path analyses were performed to investigate pathways by which psychosocial and environmental factors influenced the water provision in addition to breast milk. SETTING: Four health centres were assigned randomly to each study's arm (one control/CG and one intervention group/IG per region). PARTICIPANTS: The sample included 300 mothers of IU6M: 150 per group. RESULTS: In IG, the proportion of mothers providing water decreased from 61 % to 29 % before and after the intervention (P < 0·001), while no difference was observed in CG (P = 0·097). The EBF rate increased in IG (from 24·0 % to 53·8 %, P < 0·001) as opposed to CG (36·7 % to 45·9 %, P = 0·107). An association (P < 0·001) between the intention and the behaviour was observed in both groups. CONCLUSIONS: An intervention developed using a sound framework reduces the provision of water among IU6M and improves EBF.

A tool to assess underlying factors to water provision among Guinean children.

In many countries, water is provided to children under 6 months of age (CU6M) in addition to breast milk (BM), hence increasing the risk of child mortality and morbidity. Factors related to this practice have not been thoroughly investigated either a tool to assess them. Based on the extended theory of planned behaviour (eTPB), we aim to develop and validate a questionnaire to assess psychosocial and environmental factors that may contribute/limit the water provision in addition to BM by mothers of CU6M in the Republic of Guinea. A three-step process was used. Ten focus group discussions (FGDs) were held to identify salient beliefs related to each of the four constructs of the eTPB. Data from FGDs were used to develop a questionnaire composed of 88 items administered to 428 mothers. Exploratory factor analyses were conducted to identify latent factors for each construct. A shorter version of the questionnaire was administered to another sample of 300 mothers. Confirmatory factor analyses (CFAs) were performed. Hancock and Mueller's H reliability indices were computed on final models to assess the tool's validity and reliability. The final questionnaire included 57 items. For all four final models, most criteria for fit indices of CFA were generally met. Reliability coefficients were all equal to or above 0.90 for each construct. This research offers a tool that could be used to investigate determinants of water provision besides BM among mothers of CU6M. Further validation in other contexts is warranted.

Changes to telehealth practices in primary care in New Brunswick (Canada): A comparative study pre and during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, telehealth technologies were used in the primary health care setting in New Brunswick as a means to continue providing care to patients while following public health guidelines. This study aimed to measure these changes and examine if they improved timely access to primary care. A secondary goal was to identify which telehealth technologies were deemed sustainable by primary care providers. METHODS: This was a comparative study on the use of telehealth technology before and during the COVID-19 pandemic. Between April 2020 and November 2020, 114 active primary care providers (family physicians or nurse practitioners) responded to the online survey. RESULTS: The findings illustrated an increase in the use of telehealth technologies. The use of phone consultations increased by 122%, from 43.9% pre-pandemic to 97.6% during the pandemic (p < 0.001). The use of virtual consultation (19.3% pre-pandemic vs. 41.2% during the pandemic, p < 0.001), emails and texts also increased during the pandemic. Whereas the more structural organizational tools (electronic medical charts and reservation systems) remained stable. However, those changes did not coincide with a significant improvement to timely access to care during the pandemic. Many participants (40.1%) wanted to keep phone consultations, and 21.9% of participants wanted to keep virtual consultations as part of their long-term practice. INTERPRETATION: The observed increase in the use of telehealth technologies may be sustainable, but it has not significantly improved timely access to primary care in New Brunswick.

Odds of Anxiety and Depression Symptoms in School-Aged Children From Official Language Minority Communities.

Objectives: The aim of this paper is to assess the odds of suffering from anxiety or depression symptoms based on the presence of certain determinants of health for youth living in the province of New Brunswick, Canada, and in two linguistically different Official Language Minority Communities (OLMCs) in the same province. Methods: With a sample of 22,329 students from grades 7 to 12 in the province of New Brunswick, Canada, logistic regressions were performed to assess each determinant of health's effect on symptoms of anxiety and depression. Results: Some social determinants, like family support, social support and food insecurity, were identified as important determinants of mental health status regardless of linguistic group membership or community membership, while other determinants, such as alcohol use, cannabis use and natural environment, were more prominent in one OLMC than the other. Discussion: Social psychology and public health theories are used in an attempt to explain the results. Limitations and recommendations are also brought forward.

A measurement scale to assess responsive feeding among Cambodian young children.

The caregiver-child interaction during mealtime, which refers to responsive feeding (RF), influences child's dietary intake. In Cambodia, given the level of malnutrition, getting better knowledge of RF among young children is essential, but to do so, using an appropriate assessment tool is necessary. We aim to develop and to validate a measurement tool to assess RF in two different situations (before and after an intervention) among children 6-23 months old. This research is part of a larger trial assessing the impact of nutrition education combined or not with the provision of complementary foods on child nutritional status. The "Opportunistic Observation Form" from the Process for the Promotion of Child Feeding package was used to collect data on RF through direct observations of child's meal episodes. Data were used to define an initial scale composed of four constructs and 15 indicators. Confirmatory factor analyses (CFA) and Hancock and Mueller's H reliability indices were computed to assess the validity and reliability of the scale. The final tool was applied to baseline and endline data. At baseline, the sample included 243 pairs and, at endline, 248 pairs. The final scale included two latent constructs (RF and active feeding) that comprise three indicators for active feeding and five for RF. Criteria for fit indices of CFA were met for both constructs though better at baseline. Reliability coefficients were above 0.80 for each construct at baseline and endline. This research proposes a scale that could be used to assess active feeding and RF. Further validation is warranted in different contexts.