Health and well-being of Hutterite farmers in Alberta: Results from the Sustainable Farm Families Alberta program.

Introduction: This article describes the health and lifestyle profile of Hutterite farmers in Alberta who participated in a health literacy education program. Methods: Longitudinal quantitative and qualitative data from the sustainable farm families (SFF) Alberta program (2014-2017) were used to describe the health and lifestyle profile of Hutterites. Data were analysed using descriptive statistics and conventional and summative content analysis. Results: Four hundred and twenty-seven Hutterite men and women aged 18-75 years participated in a health literacy education program. About 50%-80% of Hutterites reported good health status, no hearing or sleeping problems, little to no body pain, fewer breathing and bladder difficulties and no constipation/diarrhoea. On average, the risk of diabetes was low (mean = 3.4) with total glucose (mean = 5.2) and cholesterol (mean = 3.5) within normal levels. Mental health outcomes such as anxiety (mean = 4.1), stress (mean = 6.7) and depression (mean = 3.1) were also within normal to mild ranges. Qualitative data showed that Hutterite farmers are committed to maintaining physical health and adopting strategies to improve mental health and lifestyle behaviours. Conclusion: Hutterites have recognisable health challenges like other rural farming communities but are aware of their physical and mental health challenges and engage in healthy lifestyle behaviours. The Hutterite tenets of living present a perfect ecological setting for sustainable health promotion intervention.

Résumé Introduction: Cet article décrit le profil de santé et de style de vie des agriculteurs huttériens de l'Alberta qui ont participé à un programme d'éducation en littératie en santé. Méthodes: Des données quantitatives et qualitatives longitudinales du programme SFF Alberta (2014 à 2017) ont été utilisées pour décrire le profil de santé et de mode de vie des Huttérites. Les données ont été analysées à l'aide de statistiques descriptives et d'une analyse de contenu conventionnelle et sommative. Résultats: Quatre cent vingt-sept hommes et femmes huttériens âgés de 18 à 75 ans ont participé à un programme d'éducation à la santé. Environ 50 à 80% des Huttériens ont signalé un bon état de santé, aucun problème d'audition ou de sommeil, peu ou pas de douleurs corporelles, moins de difficultés respiratoires et vésicales et pas de constipation/diarrhée. En moyenne, le risque de diabète était faible (moyenne = 3,4) avec une glycémie totale (moyenne = 5,2) et un taux de cholestérol (moyenne = 3,5) à des niveaux normaux. Les résultats en matière de santé mentale tels que l'anxiété (moyenne = 4,1), le stress (moyenne = 6,7) et la dépression (moyenne = 3,1) SE situaient également dans des plages normales à légères. Les données qualitatives ont montré que les agriculteurs huttérites sont déterminés à maintenir leur santé physique et à adopter des stratégies pour améliorer leur santé mentale et leurs habitudes de vie. Conclusion: Les Huttérites ont des problèmes de santé reconnaissables comme les autres communautés agricoles rurales, mais sont conscients de leurs problèmes de santé physique et mentale et adoptent des modes de vie sains. Les principes de vie huttériens présentent un cadre écologique parfait pour une intervention durable de promotion de la santé. Mots-clés: Familles d'agriculteurs durables, santé physique, santé mentale, Huttérites, promotion de la santé.

Sustainability of a rural volunteer program (Nav-CARE): a case study.

INTRODUCTION: Nav-CARE (Navigation: Connecting, Accessing, Resourcing and Engaging) is an evidence-based program that was implemented over 1 year in a rural community in western Canada. Nav-CARE uses volunteers who are trained in navigation to facilitate access to resources and provide social support to older persons living in the community with serious illness such as cancer, congestive heart failure and chronic obstructive pulmonary disease. Following implementation in which Nav-CARE was found to be feasible, acceptable and have positive outcomes, Nav-CARE was integrated into the local community-based hospice society program. Two years after a successful implementation, it continued to be sustainable in this same rural community. The purpose of this study was to explore the key factors that facilitated the sustainability of Nav-CARE in a rural hospice society. METHODS: A qualitative single case study design was used with data from several sources collected at different times: (a) pre-implementation, (b) Nav-CARE program implementation (1-year time period), (c) immediately after implementation and (d) 6 months to 2 years after implementation). Data included individual interviews with community stakeholders (n=9), the study volunteer coordinator (n=1), hospice society coordinator (n=1) and Nav-CARE volunteers (n=9). It also included meeting notes of volunteer debriefing sessions and meetings with stakeholders planning for sustainability of Nav-CARE that were held during the 1-year implementation. Data were organized using the i-PARIHS (integrated Promoting Action on Research Implementation in Health Services) framework (a well known implementation framework). Data were analyzed using Yin's qualitative case study approach. RESULTS: The findings from this case study suggested that key factors in facilitating sustainability of a rural community intervention (Nav-CARE) were the organizational context (inner context) and facilitation (facilitator and facilitation processes). Additionally, the inner context included the fit of Nav-CARE with the organization's priorities, the absorptive capacity of the organization, and organizational structure and mechanisms to integrate Nav-CARE into current programs. The hospice society was well established and supported by the rural community. The role of the facilitator and the planned facilitation processes (training of volunteer navigators, ongoing support and planning events) were key factors in the sustainability of the Nav-CARE program. The findings found that the formal role of the facilitator in the implementation and sustainability of Nav-CARE in this rural community required skills and knowledge, as well as ongoing mentorship. As well, the facilitation process for Nav-CARE included formal sustainability planning meetings involving stakeholders. CONCLUSION: Using the i-PARIHS framework and a case study approach, key factors for facilitating sustainability were identified. The role of the facilitator, the facilitation processes and the characteristics of the organizational context were important for the sustainability of Nav-CARE. Future research is needed to understand how to assess and enhance an organization's sustainability capacity and the impact of additional facilitator training and mentoring. This study provides a foundation for future research and adds to the discussion of the issue of sustainability of evidence-based interventions in rural community settings.

Developing Navigation Competencies to Care for Older Rural Adults with Advanced Illness.

Navigators help rural older adults with advanced illness and their families connect to needed resources, information, and people to improve their quality of life. This article describes the process used to engage experts - in rural aging, rural palliative care, and navigation - as well as rural community stakeholders to develop a conceptual definition of navigation and delineate navigation competencies for the care of this population. A discussion paper on the important considerations for navigation in this population was developed followed by a four-phased Delphi process with 30 expert panel members. Study results culminated in five general navigation competencies for health care providers caring for older rural persons and their families at end of life: provide patient/family screening; advocate for the patient/family; facilitate community connections; coordinate access to services and resources; and promote active engagement. Specific competencies were also developed. These competencies provide the foundation for research and curriculum development in navigation.

Hope against hope: exploring the hopes and challenges of rural female caregivers of persons with advanced cancer.

BACKGROUND: This paper focuses on the qualitative component of a study evaluating a hope intervention, entitled Living with Hope Program (LWHP), designed to foster hope in female caregivers of family members living with advanced cancer. The purpose of this research is to share, in the form of a story, the experiences of rural female caregivers caring for family members with advanced cancer, focusing on what fosters their hope. Hope is a psychosocial and spiritual resource that has been found to help family caregivers live through difficult transitions and challenges. METHODS: Twenty-three participants from rural Western Canada completed daily journal entries documenting their hopes and challenges. Cortazzi's (2001) method of narrative analysis was used to analyze the data, which was then transcribed into a narrative entitled 'hope against hope.' RESULTS: The journal entries highlighted: the caregivers' hopes and what fostered their hope; the various challenges of caregiving; self-care strategies, and; their emotional journey. Hope was integrated throughout their entire experience, and 'hope against hope' describes how hope persists even when there is no hope for a cure. CONCLUSIONS: This research contributes to the assessment of caregiver interventions that impact hope and quality of life, while illustrating the value of a narrative approach to both research and practice. Journaling may be particularly valuable for rural caregivers who are isolated, and may lack direct professional and peer support. There is an opportunity for health professionals and other providers to foster a relationship of trust with family caregivers, in which their story can be told openly and where practitioners pay closer attention to the psychosocial needs of caregivers.

Evaluation of the living with hope program for rural women caregivers of persons with advanced cancer.

BACKGROUND: Hope has been identified as a key psychosocial resource among family caregivers to manage and deal with the caregiver experience. The Living with Hope Program is a self-administered intervention that consists of watching an international award winning Living with Hope film and participating in a two week hope activity ("Stories of the Present"). The purpose of this study was to examine the effects of the Living with Hope Program on self-efficacy [General Self-Efficacy Scale], loss and grief [Non-Death Revised Grief Experience Inventory], hope [Herth Hope Index] and quality of life [Short-Form 12 version 2 (SF-12v2)] in rural women caring for persons with advanced cancer and to model potential mechanisms through which changes occurred. METHODS: A time-series embedded mixed method design was used, with quantitative baseline outcome measures repeated at day 7, day 14, and 3, 6 and 12 months. Qualitative data from the hope activity informed the quantitative data. Thirty-six participants agreed to participate with 22 completing all data collection. General estimating equations were used to analyze the data. RESULTS: Herth Hope Index scores (p=0.05) had increased significantly from baseline at day 7. General Self Efficacy Scale scores were significantly higher than baseline at all data time points. To determine the mechanisms of the Living with Hope Program through which changes occurred, results of the data analysis suggested that as General Self Efficacy Scale scores increased (p<0.001) and Non-death Revised Grief Experience Inventory scores decreased (p=0.01) Herth Hope Index scores increased. In addition as Herth Hope Index scores increased (p<0.001) and Non-death Revised Grief Experience Inventory scores decreased (p=0.01), SF-12v2 mental health summary scores increased. Qualitative data suggested that through the hope activity (Stories of the Present) the participants were able to find positives and hope in their experience. CONCLUSIONS: The Living with Hope Program has potential to increase hope and improve quality of life for rural women caregivers of persons with advanced cancer. The possible mechanisms by which changes in hope and quality of life occur are by decreasing loss and grief and increasing self-efficacy. TRIAL REGISTRATIONS: Registration ClinicalTrials.gov, NCT01081301.

Determinants of medication incident reporting, recovery, and learning in community pharmacies: a conceptual model.

BACKGROUND: Evidence suggests that the underreporting of medication errors and near misses, collectively referred to as medication incidents (MIs), in the community pharmacy setting, is high. Despite the obvious negative implications, MIs present opportunities for pharmacy staff and regulatory authorities to learn from these mistakes and take steps to reduce the likelihood that they reoccur. However, these activities can only take place if such errors are reported and openly discussed. OBJECTIVES: This research proposes a model of factors influencing the reporting, service recovery, and organizational learning resulting from MIs within Canadian community pharmacies. METHODS: The conceptual model is based on a synthesis of the literature and findings from a pilot study conducted among pharmacy management, pharmacists, and pharmacy technicians from 13 community pharmacies in Nova Scotia, Canada. The purpose of the pilot study was to identify various actions that should be taken to improve MI reporting and included staff perceptions of the strengths and weaknesses of their current MI-reporting process, desired characteristics of a new process, and broader external and internal activities that would likely improve reporting. Out of the 109 surveys sent, 72 usable surveys were returned (66.1% response rate). Multivariate analysis of variance found no significant differences among staff type in their perceptions of the current or new desired system but were found for broader initiatives to improve MI reporting. These findings were used for a proposed structural equation model (SEM). RESULTS: The SEM proposes that individual-perceived self-efficacy, MI process capability, MI process support, organizational culture, management support, and regulatory authority all influence the completeness of MI reporting, which, in turn, influences MI service recovery and learning. CONCLUSIONS: This model may eventually be used to enable pharmacy managers to make better decisions. By identifying risk factors that contribute to low MI reporting, recovery, and learning, it will be possible for regulators to focus their efforts on high-risk sectors and begin to undertake preventative educational interventions rather than relying solely on remedial activities.

Generation of priority research questions to inform conservation policy and management at a national level.

Integrating knowledge from across the natural and social sciences is necessary to effectively address societal tradeoffs between human use of biological diversity and its preservation. Collaborative processes can change the ways decision makers think about scientific evidence, enhance levels of mutual trust and credibility, and advance the conservation policy discourse. Canada has responsibility for a large fraction of some major ecosystems, such as boreal forests, Arctic tundra, wetlands, and temperate and Arctic oceans. Stressors to biological diversity within these ecosystems arise from activities of the country's resource-based economy, as well as external drivers of environmental change. Effective management is complicated by incongruence between ecological and political boundaries and conflicting perspectives on social and economic goals. Many knowledge gaps about stressors and their management might be reduced through targeted, timely research. We identify 40 questions that, if addressed or answered, would advance research that has a high probability of supporting development of effective policies and management strategies for species, ecosystems, and ecological processes in Canada. A total of 396 candidate questions drawn from natural and social science disciplines were contributed by individuals with diverse organizational affiliations. These were collaboratively winnowed to 40 by our team of collaborators. The questions emphasize understanding ecosystems, the effects and mitigation of climate change, coordinating governance and management efforts across multiple jurisdictions, and examining relations between conservation policy and the social and economic well-being of Aboriginal peoples. The questions we identified provide potential links between evidence from the conservation sciences and formulation of policies for conservation and resource management. Our collaborative process of communication and engagement between scientists and decision makers for generating and prioritizing research questions at a national level could be a model for similar efforts beyond Canada.