Abstract

Abstract

Abstract

In 2012, the Nigerian-American writer and artist Teju Cole called out the culture of white saviourism in the USA and introduced the concept of the White Saviour Industrial Complex (WSIC). The make-up of global health education perpetuates and feeds into the WSIC, with universities in high-income countries (HICs) accounting for a major share of global health programmes. Global health education is in certain respects a growth industry of whiteness that promotes justice only on paper and remains rooted in harmful colonial worldviews. Cole noted that the WSIC is “not about justice”, rather “it is about a big emotional experience that validates privilege”. This reflection applies to how global health is taught, including by us as educators based in Canada, irrespective of our roots and citizenship in Sri Lanka, Rwanda, Mexico, and India. Those who work in global health in HICs benefit from an imbalance of power that maintains the white supremacist status quo, and consequently an entrenched divide in global health. As global health educators we are then compelled to ask: are we training students to be “white saviours”, irrespective of their ethnicity or country of origin, and how can global health education be reconfigured?

Abstract

Abstract

DOI

https://doi.org/10.31223/X52Q21

Subjects

Public Health

Keywords

climate change, health, Public health, Global Health, vulnerability, adaptation, risks, Caribbean, West Indies

Abstract

Introduction: Canada’s Indigenous populations are disproportionately affected by Hepatitis C Virus (HCV). Indigenous cultures and knowledge are poorly integrated into HCV health interventions and nursing care also has deficiencies in this regard.

Objectives: The purpose of this narrative review was to analyze community-based HCV interventions in Indigenous populations in order to propose recommendations for strengthening HCV nursing practice and ensuring it responds to the needs and values of the Indigenous communities.

Methods: Rapid review methods were used. Searches were conducted in CINAHL, MEDLINE, EMBASE and Cochrane databases and using the Google search engine. The community readiness model of Stanley et al. (2014), which promotes the development of tailored interventions based on strengths, the issue and the context, guided the analysis.

Results: A total of 24 sources were used to analyze 13 intervention projects. Similarities emerged within 11/13 intervention projects applying a holistic approach (n=11) and/or a harm reduction approach (n=7), which involved a trusting, non-judgmental, and non-stigmatizing relationship. Community mobilization was inherent to all 13 intervention projects, and it is through a self-determination approach that nurses were most likely to achieve this mobilization needed for the intervention on HCV.

Discussion and conclusion: It is through the application of a holistic harm-reduction approach, that nurses can support self-determination and community mobilization to effectively reduce the burden of HCV experienced by Indigenous communities.

Abstract

Background:Adolescence is a critical period for reinforcing healthy dietary behaviors and supporting the development of cooking skills. Social media may be an avenue for supporting these behaviors, as it is popular among adolescents and can improve access to nutrition education interventions. This study sought to understand the optimal implementation of effective social media–based nutrition education interventions to inform the implementation of future social media–based nutrition education interventions.

Objective:A scoping review of the characteristics, feasibility, effectiveness, and factors influencing social media–based nutrition education interventions for adolescents was conducted.

Methods:We searched MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO databases using a predefined search strategy. Primary research articles were independently screened and included if they involved adolescent populations (10-18 years old) and delivered nutrition education through social media. The information on intervention characteristics, feasibility, effectiveness, and factors influencing social media–based nutrition education interventions was extracted.

Results:A total of 28 publications out of 20,557 met the eligibility criteria. Twenty-five nutrition interventions were examined by 28 studies. Fourteen interventions used homegrown social media platforms, 8 used Facebook, and 2 used Instagram. Feasibility outcomes were infrequently reported, and the cost of intervention delivery was not reported. Engagement with interventions was variable; high engagement was not required to elicit significant improvements in dietary behaviors. Tailoring interventions, offering practical content, meaningful peer support, and involving families and communities facilitated successful interventions. Strategies to address engagement and technical issues were varied.

Conclusions:Emerging evidence demonstrates that social media interventions for adolescent nutrition are acceptable and improve nutrition outcomes. Future interventions should strengthen peer support components and tailor delivery to specific populations. Further research should examine engagement, adherence, and the impact of interventions on behavioral and physical outcomes. This review is the first to examine the use of social media as the primary medium for nutrition education for adolescent populations. The analysis used in this review argues the importance of peer support in social media–based nutrition interventions and the need for user-centered design of the interventions.

JMIR Pediatr Parent 2023;6:e36132

doi:10.2196/36132

Background

Climate change (CC) adaptation is considered a priority for Caribbean Small Islands Developing States (SIDS), as these territories and communities are considered particularly vulnerable to climate-related events. The primary health care (PHC) system is an important actor in contributing to climate change adaptation. However, knowledge on how PHC is prepared for CC in Caribbean SIDS is very limited. The objective of this paper is to discuss health adaptation to climate change focusing on the PHC system.

Methods

We explored the perspectives of PHC professionals in Dominica on climate change. Focus group discussions (FGDs) were conducted in each of the seven health districts in Dominica, a Caribbean SIDS, between November 2021 and January 2022. The semi-structured interview guide was based on the Essential Public Health Functions: assessment, access to health care services, policy development and resource allocation. Data coding was organized accordingly.

Results

Findings suggest that health care providers perceive climate change as contributing to an increase in NCDs and mental health problems. Climate-related events create barriers to care and exacerbate the chronic deficiencies within the health system, especially in the absence of high-level policy support. Healthcare providers need to take a holistic view of health and act accordingly in terms of disease prevention and health promotion, epidemiological surveillance, and ensuring the widest possible access to health care, with a particular focus on the ecological and social determinants of vulnerability.

Conclusion

The Primary Health Care system should be a key actor in designing and operationalizing adaptation and transformative resilience. The Essential Public Health Functions should integrate social and climate and ecological determinants of health to guide primary care activities to protect the health of communities. This indicates a need for improved research on the linkages between climate events and health outcomes, surveillance, and development of plans that are guided by contextual knowledge in the SIDS.

Abstract

Immigrant and refugee populations face multiple barriers to accessing mental health services. This scoping review applies the (Levesque et al. in Int J Equity Health 12:18, 2013) Patient-Centred Access to Healthcare model in exploring the potential of increased access through virtual mental healthcare services VMHS for these populations by examining the affordability, availability/accommodation, and appropriateness and acceptability of virtual mental health interventions and assessments. A search in CINAHL, MEDLINE, PSYCINFO, EMBASE, SOCINDEX and SCOPUS following (Arksey and O’Malley in Int J Soc Res Methodol 8:19–32, 2005) guidelines found 44 papers and 41 unique interventions/assessment tools. Accessibility depended on individual (e.g., literacy), program (e.g., computer required) and contextual/social factors (e.g., housing characteristics, internet bandwidth). Participation often required financial and technical support, raising important questions about the generalizability and sustainability of VMHS’ accessibility for immigrant and refugee populations. Given limitations in current research (i.e., frequent exclusion of patients with severe mental health issues; limited examination of cultural dimensions; de facto exclusion of those without access to technology), further research appears warranted.

Le mandat

Le deuxième mandat de l’équipe de recherche indépendante découle directement des conclusions et des recommandations du premier mandat complété en 2019. Ce deuxième mandat a visé à « avoir une meilleure compréhension des interpellations afin de mieux définir leur usage et mieux prévenir les interpellations aléatoires »; à « comprendre les motivations des policiers dans le cadre des interpellations; à « évaluer l’impact de la politique sur les interpellations; à « déterminer si les interpellations sont réalisées conformément aux prescriptions de la politique »; à « évaluer la capacité [des nouveaux outils servant] à contextualiser l’interpellation policière ». Outre les nombreuses analyses statistiques à déployer, le Plan d’action soumis et approuvé par la direction du SPVM prévoyait un important volet qualitatif du mandat visant à « aborder les questions du contexte organisationnel qui sont à l’origine du mandat même et dont les policières et policiers qui seront sollicités seront évidemment conscients : l’observation de disparités ethnoculturelles dans les statistiques de l’interpellation ».

En prenant appui sur la mission de l’école québécoise qui consiste à instruire, socialiser et qualifier, le projet PhiloJeunes, implanté au Québec depuis 2015, œuvre au renforcement des facteurs de protection face à la radicalisation violente par la voie de l’implantation d’une pratique philosophique en classe. Le présent article se fonde sur une étude qualitative menée auprès de pédagogues engagés dans ce projet éducatif, afin d’explorer leur expérience lors de la formation et de l’application dudit projet. L’analyse met en lumière les défis et les leviers rencontrés par les pédagogues, notamment en regard d’une certaine prescription/proscription normative quant à l’expression et à la circulation des émotions. L’inévitable imbrication entre la sphère rationnelle et la sphère émotionnelle amène les autrices à soutenir, dans la veine de l’héritage de John Dewey, un dépassement de cette désuète opposition, afin d’embrasser une éducation démocratique sensible qui puisse favoriser la réalisation des objectifs de prévention de la radicalisation violente par la voie de la discussion philosophique en contexte scolaire.

Background

Refugees, asylum seekers, and migrants without status experience precarious living and working conditions that disproportionately expose them to coronavirus disease 2019 (COVID-19). In the two most populous Canadian provinces (Quebec and Ontario), to reduce the vulnerability factors experienced by the most marginalized migrants, the public and community sectors engage in joint coordination efforts called intersectoral collaboration. This collaboration ensures holistic care provisioning, inclusive of psychosocial support, assistance to address food security, and educational and employment assistance. This research project explores how community and public sectors collaborated on intersectoral initiatives during the COVID-19 pandemic to support refugees, asylum seekers, and migrants without status in the cities of Montreal, Sherbrooke, and Toronto, and generates lessons for a sustainable response to the heterogeneous needs of these migrants.

Abstract

bstract

Ce mémoire a été élaboré par des membres chercheuses de l’équipe Inclusion et diversité ethnoculturelle en éducation (IDEÉ) financée par le Fonds de recherche du Québec – Société et Culture. Cette équipe a pour principaux objectifs :

1. de comprendre comment le personnel scolaire contribue à produire ou à réduire les inégalités éducatives en contexte de diversité ethnoculturelle ;

2. d’identifier comment les institutions éducatives, du préscolaire jusqu’à l’université, et leurs agents peuvent contribuer à réduire les inégalités et favoriser la justice sociale ;

3. de contribuer à éclairer les politiques en éducation et en immigration, les initiatives communautaires, la formation initiale et continue du personnel scolaire et les pratiques des milieux éducatifs. L’équipe IDEÉ adopte une posture critique afin de comprendre comment certaines pratiques et certains processus structurels agissent sur la réussite éducative et sur l’expérience de tou.te.s les actrices et acteurs de l’école, notamment les actrices et acteurs de groupes minorisés ou racisés. L’équipe IDEÉ rassemble :

● 11 chercheuses régulières mobilisant une diversité d’approches de recherche et de disciplines dont la sociologie, la psychopédagogie, la psychologie sociale, la didactique et l’administration scolaire;

● 40 étudiantes et étudiants à la maitrise et au doctorat;

● 11 collaboratrices et collaborateurs des milieux de pratique travaillant dans les institutions éducatives et gouvernementales ainsi que dans des organismes communautaires.

Introduction

Abstract

Abstract

The stopmtl.ca project uses a participatory mapping methodology to allow individuals to self-report their police stop experiences in the city of Montreal, Canada. Between July 14th 2021 and December 21st 2021, a total of 714 police stop experiences were contributed to the stopmtl.ca website. Of these contributions, approximately 28% (N = 197) were removed due to a programming error that led to the duplication of cases. Of the remaining contributions (N = 517), 21% were suspected fake data and 7% were excluded due to missing data. A total of 369 contributed police stop experiences were retained (71%). A descriptive analysis of the data suggests that most police stop experiences were reported by men (74%), individuals who identified as being White (55%), hetereosexual (70%) and being aged between 19 and 24 years (27%). A Black racioethnic identity was the second most frequent racioethnic identity (17%). In terms of spatial distribution, stop experiences were reported as occurring most frequently in the Côte-des-Neiges (13%) and Ville-Marie (12%) boroughs of Montreal. Nearly half of all reported stops were reported as having occurred in 2021 (49%), and most frequently in the summer months (May-August) (65%), peaking in July (33%). The most frequent activity individuals reported doing during their stop was being in a vehicle (42%), followed by walking (23%). Respondents could identify multiple reasons for which they believed they were stopped. The perceived reason for the stop most frequently identified was what the person was doing (39%), followed by their appearance (30%). Roughly equal proportions of police stops were seen as justified (41%) and as not justified (43%). There are several similarities between the characteristics of self-reported police stop experiences contributed to stopmtl.ca and police-recorded stops in the city of Montreal, Canada. Namely, there appears to be a comparable spatial distribution of police stops in both data sets, as well as some indication of a comparable social distribution (e.g., gender, age and racioethnic identities of those stopped). However, the self-reported police stop data is limited in several important ways. Namely, for self-reported police stops with available data on whether the respondent received a sanction following their stop (i.e., fine, arrest or charge) (N = 129), 42% were said to have led to a sanction. This limits the capacity to draw strong comparisons between self-reported data and police-recorded data (which excludes all stops leading to a sanction). Though criteria were applied to exclude suspected fake data, it is not possible to establish the veracity of self-reported stops. Nevertheless, these preliminary descriptive results provide a snapshot of who self-reported their stops and of the types of stops that led to self-reports. Furthermore, the data provide insight into citizens’ perceptions of their police stop experiences. Future directions for research, including planned validation analyses and a second wave of data collection are discussed.

Abstract

Le rapport présente notre recherche sur l’expérience des parents d’enfants trans ou non-binaires dans la région du Saguenay-Lac-Saint-Jean. La méthodologie utilisée est qualitative et phénoménologique, entretiens et analyses herméneutiques contextuelles critiques. Nous avons rencontré quinze parents de la région. Les résultats ont montré que les parents ont vécu un stress parental accru lié à la transphobie, aux normes de binarité de genre et à la cisnormativité, mais aussi en raison de l’absence de services adaptés pour répondre à leurs besoins d’information, de soutien, notamment psychologiques et de soins trans affirmatifs pour leurs enfants. Les résultats décrivent plusieurs dynamiques psychologiques : un choc initial lié au coming out, vécu par les parents et pouvant affecter leur capacité de mentalisation, entraînant parfois des difficultés sur le moment à comprendre, à maintenir une relation et à réagir de manière ajustée à la situation. Les résultats ont également montré des temporalités et des rythmes dysharmoniques entre parents et enfants ainsi que la nécessité de négocier une temporalité et une expérience commune. Les facteurs concomitants majorant le stress parental présents dans cette recherche incluent les inégalités économiques, la présence de trauma dans l’histoire familiale et les troubles de santé mentale au sein de la famille. Le rapport met en évidence la richesse des expériences parentales et l’importance de respecter leur caractère unique. Le rapport propose des recommandations pour les parents, les professionnel·le·s de la santé et pour promouvoir l’inclusivité dans la société.

Nos membres Naïma Bentayeb et Lara Gautier sont les responsables du dernier numéro de la revue Alterstice sous le thème “Expérience des réfugiés, demandeurs d’asile et migrants sans statut et offre de services de santé et sociaux pendant la pandémie au Québec”. 

Plusieurs autres membres de SHERPA ont contribué à ce numéro dont Janet Cleveland, Jill Hanley, Patrick Cloos, Mélanie M. Gagnon et  Andréanne Dufour, membre de notre équipe.

Note:
Funding Declaration: We would like to acknowledge the support of Manon Lapierre, Director of Operations at La Maison Bleue, towards the realisation of this project. Additionally, we recognize the support provided to C.Woronko by the Ordre des infirmières et infirmiers du Québec Bourses de fin d’études à la maîtrise – 2021-2022. A Cuerrier acknowledges the support provided by the Ingram School of Nursing, McGill University, for the Student Research Support received. L Merry, P Li and A Van Hulst acknowledge the support received through Fonds de la recherche du Québec en santé Research Salary Awards.

Abstract

Abstract

In the wake of the killing of George Floyd on May 25, 2020, there was a strong call to action, first in North America and then globally, to tackle racism and promote racial justice . Many universities created “equity, diversity, inclusion, anti-racism (EDI-AR)” task forces and other mechanisms with goals of transforming institutions entrenched in histories of colonialism and white supremacy. Concurrently, decolonizing global health movements have been gaining momentum asking all stakeholders including academic institutes to advance equity and dismantle systemic forms of oppression .

Often equity efforts initiated during watershed moments face the challenge of losing team. The crescendos and unavoidable reckoning with every individual’s relationship to structural injustices ultimately dwindle and the status quo in academia continues to instill ingrained systems of discrimination. Deliberate equity building in academia including decolonizing curricula and institutional practices are also highly relevant to addressing structural fault lines in global health governing models, implementation practices and research partnerships . Lessons from failures in Covid-19 pandemic and climate crisis highlight the urgency to better equip students and faculty to lead equity centered approaches.

In this essay, we highlight six key considerations that senior leadership and community at large within high income country (HIC) global health academic institutions need to be mindful to successfully embed equity efforts into the fabric of their foundation. While our experiences as authors stem largely from our engagement in global health academia, the following reflections cut across disciplines.

This chapter, based on results from a qualitative research project commissioned by the Canadian Department of Justice, analyzes the availability of protection services for victims of trafficking in persons in Canada from the perspective of demand and supply.1 A first objective is to identify and highlight discrepancies between the “demand” for victim protection services versus the “supply” of community-based services. A second objective is to determine the root causes of these discrepancies. The voices of the NGOs who participated in the project will illustrate these dynamics. Policy recommendations to correct the imbalances between victims’ needs for services and NGOs’ ability to provide those services will conclude the chapter. 1. Despite the convention which usually places the word supply first when referring to supply and demand, the authors choose to inverse the terms in order to emphasize the demand aspect.

An overview of the phenomenon of human trafficking will situate the Canadian experience within an international context and the evolution of awareness and debates around trafficking among Canadian academics, policymakers and practitioners will be discussed. A brief description of the research project on which this chapter is based will be offered. The authors will specify the methodology applied and the results will be presented, discussing how the theory of demand and supply can be used to understand the dynamics surrounding community-based services for trafficking victims. The voices of NGOs, expressed through interview data, will illustrate the “demand” for services in terms of the needs of victims NGOs encounter and the “supply” of such services by community-based actors. An analysis of the gaps that exist between the demand and supply of services will precede the final section where policy recommendations will be offered to diminish the gaps in the hopes of better respecting the human rights of the victims of human trafficking.

This study examines the association between gender identity, mental health, social adversity, and sympathy for violent radicalization (VR). Data were collected through an online survey in Canada. A total of 6003 eligible participants who were residents of Montreal, Toronto, Calgary, or Edmonton and aged from 18 to 35 years were included. We used Fisher exact test to assess gender differences in gender-based discrimination and we used analysis of variance tests to assess differences in scores on bullying, mental health, and sympathy for VR. We used linear regression to assess the relationship between mental health, social adversities, and sympathy for VR. Individuals who self-identified as trans and gender diverse had greater sympathy for VR than females did, experienced online victimization more frequently, and reported higher levels of psychological distress than both male and female participants. Our findings indicate that more research is needed on the association between social adversity and support for VR among this vulnerable population.

Dans un contexte où les inégalités d’accès aux soins psychiatriques sont de plus en plus reconnues comme un enjeu préoccupant de santé publique dans les pays de la région subsaharienne, et alors que les représentations sociales associées aux troubles mentaux exercent une influence notable sur cet accès aux soins, celles-ci ont suscité jusqu’à présent peu de travaux. Dans cet article, nous appréhendons les entités nosologiques populaires et leurs principales caractéristiques en milieu urbain au Burkina Faso. Pour ce faire, 7 groupes de discussion et 16 entretiens individuels ont été menés auprès de différents acteurs dans la ville de Bobo-Dioulasso. Une analyse thématique a permis d’identifier deux entités nosologiques populaires. Le terme Kougolobana renvoie à une altération du cerveau associée à l’envoûtement par des entités surnaturelles et s’exprime sporadiquement ; alors que le terme Fatoya renvoie à une condition incurable causée par la commission d’actes transgressifs de différentes natures. Nos résultats mettent en lumière l’influence mutuelle des registres traditionnels et biopsychosociaux dans la construction de ces entités nosologiques. Ces résultats permettent d’amorcer une réflexion sur la place centrale qu’occupe la notion de transgression dans les représentations sociales des troubles de santé mentale dans la ville de Bobo-Dioulasso.

Background: The number of people living with type 2 diabetes (T2D) is increasing worldwide. The prevalence rate of this disease is generally higher in the migrant population compared to the general population. However significant inequalities in the prevalence of T2D are notable between and within migrant populations. Among them, migrants from sub-Saharan Africa, South America and South Asia are more affected than those of European origin. The act of eating and the corporality play an essential role in the development of this disease. Dietary and body norms systems favorable to the prevention and control of type 2 go against what is vital for most of these people, exposing them to conflicts of norms that are difficult to reconcile. 

Objectif: to identify factors that may influence the acceptance or rejection of dietary and body norm systems favorable to the prevention and control of T2D by Sub-Saharan Africa migrants living with T2D. 

Materials and methods: Scoping review according to the steps described by Arksey and O’Malley (2005) will be conducted. An electronic search of studies from 2011 to 2022, published English, Italian, French or in Portuguese will be conducted in eight databases (CINAHL, Cochrane library, Embase, Google Scholar, PsycInfo, PubMed, Scopus, and Web of Sciences). The grey literature including publication in Open Grey database and Website of non-governmental organizations working on migrant from Sub-Saharan Africa will be searched. All articles related to body norms, dietary behaviors, or determinants of body behaviors and dietary of migrants from Sub-Saharan Africa and those related to factors that influence acceptance or rejection of dietary and body norms systems favorable to the prevention and control of T2D among the migrants from Sub-Saharan Africa living with T2D or at risk to develop this disease will be included. This scoping review will be reported following the Standard Protocol Items: Recommendations for interventional Trials (SPIRIT) and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. 

Results: The results will focus on factors influencing the acceptance or rejection of dietary and body norms systems favorable to the prevention and control of T2D among the migrants from Sub-Saharan Africa living with T2D or at risk to develop it.

The COVID-19 pandemic highlighted the impact of social inequalities in health (SIH). Various studies have shown significant inequalities in mortality and morbidity associated with COVID-19 and the influence of social determinants of health. The objective of this qualitative case study was to analyze the consideration of SIH in the design of two key COVID-19 prevention and control interventions in France: testing and contact tracing. Interviews were conducted with 36 key informants involved in the design of the intervention and/or the government response to the pandemic as well as relevant documents (n = 15) were reviewed. We applied data triangulation and a hybrid deductive and inductive analysis to analyze the data. Findings revealed the divergent understandings and perspectives about SIH, as well as the challenges associated with consideration for these at the beginning stages of the pandemic. Despite a shared concern for SIH between the participants, an epidemiological frame of reference dominated the design of the intervention. It resulted in a model in which consideration for SIH appeared as a complement, with a clinical goal of the intervention: breaking the chain of COVID-19 transmission. Although the COVID-19 health crisis highlighted the importance of SIH, it did not appear to be an opportunity to further their consideration in response efforts. This article provides original insights into consideration for SIH in the design of testing and contact-tracing interventions based upon a qualitative investigation.

When approaching the multiplicity of the spiritual experiences of healing, ethnographers are often presented with ideas of the existence of “other” worlds that may intersect with the so-called “material” or “physical” worlds. This book proposes a sensory ethnography of healing with a focus on ethnographic knowing as embedded in an embodied epistemology of healing. Epistemological embodiment signals that personal scholarly experience of the “unknown”—be it in the form of trance, or as the embodiment of an “other”—shapes the concepts of healing, body, trance, self, and matter by which ethnographers craft out analysis.

Digital technology offers several opportunities to improve access to professional expertise in primary care, and the offer of various “virtual” services has exploded in the past few years. The aim of this study was to evaluate the implementation of a direct-to-consumer on-line pharmacy consultation service (Ask Your Pharmacist – AYP) to a universal phone consultation service led by the universal public health system in Quebec (811 Info-Santé), through a direct bridge. Semi-structured interviews were conducted with clinician users of the service, and stakeholders involved in this pilot project funded by the Ministry of Economy (n = 22); documents were also analyzed, and content of the question was asked through the AYP service. Adoption of the service was low, and it suggests a poor alignment between the need and the service as implemented. Further research should investigate the mechanisms for an appropriate integration of digital services for primary care universal consultation services.

Background

Children in Afghanistan live in dangerous areas, and have been exposed to traumatic events and chaotic education. Progress has been made on access to education for girls who were the most affected by traditional attitudes against engagement in education.

Objectives

The objectives were to evaluate the mental health of Afghan children living in regions of conflict and the association of mental health with school attendance for girls and boys.

Method

The study included 2707 school aged children in eight regions of Afghanistan (16 provinces) residing in households recruited through a multi-stage stratified cluster sampling strategy in 2017. The level of terrorist threat was evaluated by the intensity of terrorist attacks recorded that year in each province. Child mental health was assessed with the parental report Strengths and Difficulties Questionnaire (SDQ) along with information on school attendance, sociodemographic characteristics and geographic location.

Results

A total of 52.75% of children had scores above threshold for the SDQ total difficulties score, 39.19% for emotional difficulties, 51.98% for conduct challenges, and 15.37% for hyperactivity/inattention. Peer relationship problems were high (82.86%) and 12.38% reported that these problems impacted daily life. The level of terrorist threat was associated with SDQ total difficulties (Adjusted Odds Ratio [AOR] = 4.08, P < 0.0001), with youth in regions with high levels of terrorist threat more likely to have problems than youth in regions with low or medium levels of danger, independent of region and ethnicity. School attendance was negatively associated with emotional symptoms (AOR = 0.65, P < 0.0001) and mental health difficulties with impairment (AOR = 0.67, P = 0.007), but positively associated with peer relationships difficulties (AOR = 1.96, P > 0.0001). Conduct (AOR = 1.66, P < .0001) and SDQ total difficulties (AOR = 1.22, P = 0.019) were higher among boys. Overall, gender did not modify the relationship between school attendance and child mental health.

Conclusion

Attending school is essential for children’s mental health, across gender, and should be supported as a priority in Afghanistan despite the return of the Taliban.

Inequalities in access to psychiatric care are increasingly recognized as a serious public health issue in sub-Saharan Africa. In these countries, little information is available regarding social representations of mental disorders, although these can have a significant influence on access to care. In this article, we examine the popular nosological entities and their characteristics in urban Burkina Faso. To do so, 7 focus groups and 16 individual interviews were conducted with various actors in the city of Bobo-Dioulasso. A thematic analysis revealed two popular nosological entities. The term Kougolobana refers to an alteration of the brain associated with bewitchment by supernatural entities and is expressed sporadically; whereas the term Fatoya refers to an incurable condition caused by the commission of transgressive acts of various kinds. Our results highlight the mutual influence of traditional and bio-psycho-social registers in the construction of these nosological entities. These results allow us to reflect on the centrality of the notion of transgression in the social representations of mental health disorders in the city of Bobo-Dioulasso.

Les troubles mentaux et plus largement les souffrances psychologiques et sociales sont aujourd’hui un des problèmes majeurs de santé dans le monde. Au regard de la charge mondiale causée par ces troubles, l’Assemblée mondiale de la Santé a adopté en mai 2012 une résolution préconisant une réponse globale coordonnée au niveau des pays pour répondre aux besoins de prise en charge des troubles mentaux. Ainsi, dans la perspective d’une recherche visant à améliorer la santé mentale et parvenir à promouvoir la santé pour tous (Patel & Prince, 2010), la présente étude s’intéresse à comprendre les représentations sociales et culturelles de la santé et de la maladie mentale, à la lumière de la dépression et du suicide en contexte africain.

2La dépression est classée comme un trouble mental courant présent à travers le monde et les cultures sous différentes manifestations (Bellanger et al., 2001). La dépression est une affection fréquente dans le monde qui touche environ 322 millions de personnes soit environ 4.4 % de la population mondiale (OMS, 2015). Le nombre total de personnes vivant avec la dépression a augmenté de 18,4 % entre 2005 et 2015. Elle est souvent décrite comme se caractérisant par une tristesse, une perte d’intérêt ou de plaisir, des sentiments de culpabilité ou de dévalorisation de soi, un sommeil ou un appétit perturbé, une certaine fatigue et des problèmes de concentration. La dépression peut perdurer ou devenir récurrente, entravant ainsi de façon substantielle l’aptitude d’un individu à fonctionner au travail ou à l’école ou à faire face à sa vie quotidienne. Elle peut également dans certains cas conduire au suicide (OMS, 2020).

3La dépression affecte outre l’individu atteint, son entourage, et représente également un lourd fardeau social et économique. Dans sa publication « Dépression : parlons-en » de mars 2017, l’OMS met en avant non seulement la souffrance des personnes atteintes de maladies mentales, mais également le coût socio-économique important de ces maladies. En effet, selon ce rapport, la perte économique mondiale relative au manque de reconnaissance et d’accès aux soins en cas de dépression ou autres troubles mentaux comme l’anxiété se chiffrerait à 1 000 milliards de dollars américains par an. Ce fardeau, pesant sur les familles, les employeurs et les gouvernements. En raison de son impact sur le fonctionnement humain et de sa propension croissante actuelle, la dépression se présente comme la première cause d’incapacité dans le monde (OMS, 2020).

4Selon la forme, la dépression peut être durable ou récurrente. Elle résulte d’interactions complexes entre les facteurs sociaux, psychologiques et biologiques. La forme majeure de dépression fortement corrélée au risque de suicide est la dépression durable (Shea et al., 2008). De plus, la dépression et l’anxiété semblent être des facteurs de risque pour le suicide en association avec des facteurs individuels et contextuels (Turecki & Brent, 2016).

5Les dépressions majeures, les addictions, la schizophrénie, les troubles bipolaires et les personnes souffrant de troubles sévères de la personnalité de type état limite sont également à risque d’idées suicidaires et de suicide (Fawcett et al., 1993).

6Le comportement suicidaire associé à la dépression majeure, est souvent conceptualisé le long d’un spectre allant de pensées suicidaires à la tentative de suicide et à la mort, en passant par l’élaboration de projets suicidaires (Findlay, 2017). En 2015, on estime que 788 000 personnes sont décédées dans le monde des suites du suicide ce qui représente 1,5 % de tous les décès, plaçant le suicide au niveau des vingt principales causes de décès. Le taux de suicide varie en fonction de l’âge, du sexe et du niveau socio-économique des régions. Selon les données recueillies par l’OMS, le suicide représente aussi 50 % des morts violentes chez les hommes 71 % chez les femmes et il est la deuxième cause de mortalité chez les 15-29 ans. Dans les pays les plus riches, trois fois plus d’hommes que de femmes décèdent par suicide, contre 1,5 fois dans les pays à revenu faible et intermédiaire. Le suicide prélève ainsi un lourd tribut en vies humaines.

7Diverses études ont traité de la question de la dépression, du suicide et leurs représentations pour les communautés culturelles (Rodiguez et al, 2022). Dans notre étude, nous souhaitons spécifiquement nous intéresser aux représentations sociales associées à la souffrance psychologique, notamment la dépression, afin de soutenir des stratégies de préventions et d’interventions concernant le suicide non stigmatisantes et centrées sur les communautés (Rivera et al., 2021).

8À noter qu’en dépit des avancées scientifiques en matière de traitement des maladies mentales, dans les pays à revenus faible ou intermédiaire, entre 76 % et 85 % des personnes ne bénéficient d’aucun traitement (OMS, 2020). Le manque de ressources, la pénurie de soignants qualifiés, les erreurs de diagnostics, la stigmatisation sociale et le tabou liés aux troubles mentaux sont autant d’obstacles à l’accès et à l’administration de soins efficaces. Ces considérations subjectives pourraient être des indicateurs du comportement des individus, notamment leur choix de solliciter ou non l’aide des spécialistes ou même à commettre des actes comme le suicide.

9Plusieurs auteurs ont proposé une définition du concept des représentations sociales. Toutefois, la définition qui répond le mieux aux besoins de notre étude est celle de Jodelet (1989) qui définit les représentations sociales comme des phénomènes complexes (éléments informatifs, cognitifs, idéologiques, normatifs, croyances, valeurs, attitudes, opinions, images, etc.) organisés sous la forme d’un savoir disant quelque chose sur l’état de la réalité toujours activée et agissant dans la vie. Cette définition prend en considération différents concepts tels que l’environnement social aussi bien que l’aspect comportemental qui en découle.

10Ainsi, notre question de recherche est de savoir si les représentations sociales de la dépression et du suicide exercent une influence sur ceux-ci, le but étant de découvrir les meilleures pratiques de prévention, intervention et postvention.

Case formulation is used in clinical training to weave together theoretical perspectives and support a shared plan of action. Although a cornerstone of clinical practice, critical social theorists have highlighted the risks of depoliticizing political struggles and of reifying and fixing subjects when using psychopathology and case formulation to address situations of injustice. In the field of violent radicalization, this risk is increased by the extreme affects evoked by terror in practitioners and in societies. This article explores the challenges of training clinicians in the field of violent radicalization. It does so by analyzing a Community of Practice (CoP) that was developed to support practitioners involved in this domain of practice in Quebec, Canada. Four focus groups with CoP participants and participant observation of nine CoP meetings were conducted. Thematic and narrative analyses were used to explore the training potential of the CoP and to identify the discursive processes and group dynamics associated with this modality. Results indicate that the diversity of professional perspectives and social positionalities in the group plays a central role in helping participants become aware of their biases and in developing more complex understandings of cases and of their social embedding. Results also suggest that the collective holding of risk is key to preserve practitioners’ investment in patients involved with violent radicalization. The sensitive issue of partnership between health and social services and security agencies is also addressed. Results suggest that CoPs with strong leadership allow for experiential training to enhance clinical and critical thinking.

Case formulation is used in clinical training to weave together theoretical perspectives and support a shared plan of action. Although a cornerstone of clinical practice, critical social theorists have highlighted the risks of depoliticizing political struggles and of reifying and fixing subjects when using psychopathology and case formulation to address situations of injustice. In the field of violent radicalization, this risk is increased by the extreme affects evoked by terror in practitioners and in societies. This article explores the challenges of training clinicians in the field of violent radicalization. It does so by analyzing a Community of Practice (CoP) that was developed to support practitioners involved in this domain of practice in Quebec, Canada. Four focus groups with CoP participants and participant observation of nine CoP meetings were conducted. Thematic and narrative analyses were used to explore the training potential of the CoP and to identify the discursive processes and group dynamics associated with this modality. Results indicate that the diversity of professional perspectives and social positionalities in the group plays a central role in helping participants become aware of their biases and in developing more complex understandings of cases and of their social embedding. Results also suggest that the collective holding of risk is key to preserve practitioners’ investment in patients involved with violent radicalization. The sensitive issue of partnership between health and social services and security agencies is also addressed. Results suggest that CoPs with strong leadership allow for experiential training to enhance clinical and critical thinking.

Background: Wanting to offer culturally sensitive services to a diverse population, rehabilitation counsellors employed by a workers’ compensation board (WCB) in a Canadian province asked the researchers to provide them with support to develop their intercultural competencies. A collaborative research design was suggested as a potential way to make full use of experiential knowledge. This article presents an action research approach in which study participants were also active in the development of new knowledge and sought to become key players in organizational change. Objective: The objective of this article is to present the steps involved in the co-construction of an intercultural communication support tool and to describe the mechanisms and structure put in place to develop the tool. Methodology: A working group (WG), a steering committee (SC) and a validation group (VG) were created, and each met on a regular basis over approximately 18 months. Several methodological approaches and data collection tools were used: participant observation charts, diaries, an “intercultural situation” workshops. Results: A total of 28 people participated in the project, in addition to the three researchers. The study showed the importance of integrating three dimensions—the individual, collective, and organizational—into the definition of intercultural competence. It soon became evident in our study that a self-reflection process grounded in a collective learning approach was the core component of the entire process of developing intercultural competencies. This finding went well beyond the production of any materials (practical guides, checklists, and supporting documents) that resulted from this process.

Given the increasing value placed on research among social work practitioners, and that field education is primarily responsible for the integration of social work values, knowledge, and practice, it is essential that research skills be incorporated into BSW and MSW field practica. In 2020, a team of faculty co-investigators and students explored the integration of research activities into Canadian BSW and MSW field practica through the review of online field education materials of all accredited programs. We make the argument that not only is it essential for professional social workers to receive training in practice research, but also that there is much room for us to integrate such research into field education. We begin with a review of the literature regarding social work student attitudes toward research, widely known to be hesitant and even hostile, before discussing the limited international literature (English and French) on the experience of integrating research into field education. After describing our methods, we then present our findings in terms of BSW and MSW programs at Canada’s anglophone and francophone universities. We conclude with a discussion of the implications in terms of ways to increase the role of research in field practica.

Dès le début de la pandémie de COVID-19, des études, principalement quantitatives, ont mis en lumière les bouleversements importants vécus par les enfants, adolescent.e.s et leurs familles. En effet, les mesures sanitaires instaurées pour contrer la pandémie (ex.: fermeture des écoles et des services de garde éducatifs) ont transformé le quotidien des jeunes et perturbé le fonctionnement de presque tous les systèmes (ex. : soins de santé, éducation) qui permettent d’assurer le bien-être des individus) (Ellis et al., 2020; Gayatri et Irawaty, 2021; Jiao et al., 2020; O’Reilly et al., 2020; Prime, Wade et Browne, 2020). Si les parents, les chercheur.e.s, les intervenant.e.s et les décideur.e.s sont inquiets des impacts de la pandémie sur les jeunes, on ignore si les jeunes sont aussi inquiets pour eux. elles-mêmes. Normal, puisque peu d’études ont questionné les enfants et les adolescent.e.s sur leurs perceptions des impacts de la pandémie.

Ce rapport technique documente les résultats d’une enquête menée en 2022 auprès du personnel de première ligne des organismes membres de la TCRI, la Table de concertation des organismes au service des personnes réfugiées et immigrantes. Un sondage auprès des gestionnaires fait l’objet d’un rapport distinct. Le sondage a été réalisé en collaboration avec OCASI, l’Ontario Council of Agencies Serving Immigrants, et la TCRI par le biais de Building Migrant Resilience in Cities/ Immigration et résilience en milieu urbain (BMRC-IRMU), un partenariat financé par le Conseil de recherches en sciences humaines (CRSH). Un groupe de travail sur les services d’accueil des nouveaux arrivants composé de membres de la communauté et d’universitaires du BMRC-IRMU ont aidé à orienter la recherche. L’instrument de sondage a été approuvé par le Comité d’examen des participants humains de l’Université York. Du point de vue des travailleurs de première ligne, le sondage examine les impacts de la COVID-19 sur eux, les clients et les organismes québécois au cours de la période de douze mois suivant la première vague de la pandémie. De nombreuses questions sont similaires à un sondage antérieur mené par OCASI et portant sur la première vague de la pandémie.

Accumulation of diverse mutations across the structural and nonstructural genes is leading to rapid evolution of SARS-CoV-2, altering its pathogenicity. We performed whole genome sequencing of 239 SARS-CoV-2 RNA samples collected from both adult and pediatric patients across eastern India (West Bengal), during the second pandemic wave in India (April–May 2021). In addition to several common spike mutations within the Delta variant, a unique constellation of eight co-appearing non-Spike mutations was identified, which revealed a high degree of positive mutual correlation. Our results also demonstrated the dynamics of SARS-CoV-2 variants among unvaccinated pediatric patients. 41.4% of our studied Delta strains harbored this signature set of eight co-appearing non-Spike mutations and phylogenetically out-clustered other Delta sub-lineages like 21J, 21A, or 21I. This is the first report from eastern India that portrayed a landscape of co-appearing mutations in the non-Spike proteins, which might have led to the evolution of a distinct Delta subcluster. Accumulation of such mutations in SARS-CoV-2 may lead to the emergence of “vaccine-evading variants.” Hence, monitoring of such non-Spike mutations will be significant in the formulation of any future vaccines against those SARS-CoV-2 variants that might evade the current vaccine-induced immunity, among both the pediatric and adult populations.

This article aims to study teaching activity in a multiethnic context. Data were collected in the context of a research project in Québec about reconstruction of teachers’ stories of practice in a multiethnic environment. More specifically, the article explores the reasons that induce three teachers to make their decisions to face a problematic situation with an immigrant student, by virtue of the prescriptions and the context of their class. The results show three ways of implementing the teaching activity: complying with the prescriptions, manipulating the prescriptions and acting on the prescriptions.

This study documents immigrant men’s use of Quebec healthcare and social services. It begins by sketching a portrait of the physical health and psychological well-being of these men. It then looks at their use (or non-use) of these services and explores both the barriers they encounter while trying to access services and factors facilitating their use of services. Finally, it examines the expectations and perceptions immigrant men have of these services. Transversally, the impact of the COVID-19 pandemic and confinement measures on the various sub-themes was specifically examined, since all of the data was collected in the context of the pandemic.

Extract

Abstract

Racism, white supremacy, and power have come under intimate inquiry, and deeper perspectives are coming to the fore as we reckon with structural injustices, societally and within our professions in medicine, public health, and academia. Our respective fields can no longer deny the existence of systemic racism and how it affects the health of Indigenous, Black, and racialised diaspora communities. The very practice of medicine perpetuates colonialism and racism on multiple levels, such as erroneously including race as a risk factor for disease and the dominance of Euro-ethnocentric scientific methods in medicine. As settler women of Chinese and South Asian descent in Canada, we are trying to make sense of the societal upheavals that have shaken us while existing in the liminal professional space we occupy.

In the fight against infectious diseases, social inequalities in health (SIH) are generally forgotten. Mali, already weakened by security and political unrest, has not been spared by the COVID-19 pandemic. Although the country was unprepared, the authorities were quick to implement public health measures, including a SARS-CoV-2 testing programme. This study aimed to understand if and how social inequalities in health were addressed in the design and planning for the national COVID-19 testing policy in Mali. A qualitative survey was conducted between March and April 2021 in Bamako, the capital of Mali. A total of 26 interviews were conducted with key government actors and national and international partners. A document review of national reports and policy documents complemented this data collection. The results demonstrated that the concept of SIH was unclear to the participants and was not a priority. The authorities focused on a symptom-based testing strategy that was publicly available. Participants also mentioned some efforts to reduce inequalities across geographical territories. The reflection and consideration of SIH within COVID-19 interventions was difficult given the governance approach to response efforts. The urgency of the situation, the perceptions of COVID-19 and the country’s pre-existing fragility were factors limiting this reflection. Over time, little action has been taken to adapt to the specific needs of certain groups in the Malian population. This study (re)highlights the need to consider SIH in the planning stages of a public health intervention, to adapt its implementation and to limit the negative impact on SIH.

ABSTRACT

The association of ideologically motivated violence with mental health disorders raises spe-cific challenges for security agencies and clinical services. The aim of this paper is todescribe the clientele of a specialized intervention program based in Montreal, Quebec, interms of type of violent ideology and clinical presentation. We conducted a retrospectivechart review of 156 individuals referred for violent extremism who received clinical servicesbetween 2016 and 2021. Univariate statistics were used to present a description of clientsociodemographic and clinical characteristics. Roughly a third of clients referred for violentextremism presented non-ideologically based violence (32.6%), followed by 31.4% affiliatedwith far-right extremist ideology and over a quarter (25.6%) holding extremist views on gen-der. Over a third of these individuals had a stress-related (35.7%) and/or mood and anxietydisorder (36.9%), followed by 28% with an autism spectrum disorder diagnosis. The majorityhad some previous contact with mental health services. A significant number of clients dis-playing extremist discourses and/or actions needed psychiatric services but often failed toreceive them because of the reluctance of clinicians to work with individuals perceived ashigh risk; in addition, individuals may be reluctant to engage in services perceived to bepart of a socio-political system they reject. Specialized services are important as a means toprovide mental health care to this group and also to develop knowledge and best practicesfor working with this clientele and provide consultation to mainstream mental health serviceproviders.

KEYWORDS

Violent extremism; clinicalservices; mental health care;specialized intervention

Abstract

Purpose

To elicit stakeholder perspectives on the findings from our scoping review on youth participation in mental health policymaking, we conducted a global consultation with young people and adults directly involved in mental health policymaking.

Method

Forty-four stakeholders from 16 countries, including 15 young people, 9 policymakers and 20 facilitators of youth participation, took part in individual interviews and/or focus groups. They were asked about how the review findings contrasted with their own experiences in mental health policymaking. The transcribed data were thematically analyzed.

Results

All participants viewed lived experience as valuable in identifying policy gaps. Youth pointed out that children and youth with disabilities, diverse sexual orientations, and/or gender identities were often excluded, and spoke about feelings of being an “accessory”, illustrating a lack of power-sharing in a tokenized policymaking process. Adult participants’ accounts highlighted the challenges inherent in policymaking such as the need for political knowledge and institutional time constraints. A range of cultural, socio-economic, and political barriers to youth participation, that were often context-specific, were identified.

Conclusions

The diverse perspectives of stakeholders extended the review results. Based on our findings, we recommend that adults and institutions: (1) recognize lived experience as expertise in shaping mental health policies; (2) include diverse groups; (3) reduce tokenistic relationships through the creation of safer spaces, adult feedback, co-production, and social accountability; and (4) adopt an intersectional approach to address cultural, socio-economic, and political barriers to participation. Methodologically, our work demonstrates why stakeholder consultations are an essential component of scoping reviews.

Introduction : Au Burkina Faso, le manque d’études sur les itinéraires thérapeutiques en santé mentale limite la compréhension des obstacles associés au recours aux soins. Comme dans plusieurs pays d’Afrique subsaharienne, cette situation se traduit par une difficulté des systèmes de santé à adapter l’offre de soins disponible à la réalité des personnes souffrant de troubles mentaux.
But de l’étude : Dans cette étude, des observations participantes ont été faites ; sept groupes de discussion et 25 entretiens individuels ont ainsi été organisés afin d’explorer les représentations sociales et l’utilisation des soins existants en santé mentale. Différents acteurs ont été interrogés : patients, soignants, accompagnants et informateurs clés.
Résultats : Une analyse thématique a révélé la présence de trois systèmes de soins dans la ville de Bobo-Dioulasso : 1) les soins psychiatriques associés à une fonction diagnostique et à la prise en charge de pathologies graves ou déclenchées par des causes « naturelles », 2) les soins traditionnels perçus comme ayant une fonction de guérison pour les pathologies « surnaturelles », mais associés à un risque d’escroquerie, et 3) les soins informels prodigués par la famille identifiés comme représentant le pilier des itinéraires thérapeutiques.
Conclusions : Cette étude révèle qu’à travers la diversité des ressources consultées, l’entourage direct représente le principal pourvoyeur de soins et que les contraintes financières constituent l’obstacle principal aux recours aux soins. Ce constat nous amène à formuler des recommandations relatives à l’élaboration d’éventuelles politiques publiques à l’échelle nationale ainsi qu’à l’organisation des services de santé dans la ville de Bobo-Dioulasso.

Le projet de recherche-action à l’origine de ce bilan est né d’une collaboration entre le Regroupement pour la Valorisation de la Paternité (RVP) et l’Institut universitaire SHERPA. Il a pour objectif de sensibiliser et d’outiller les organismes communautaires (organismes de soutien à la famille et organismes d’accueil des immigrants) à l’adaptation de leurs services afin de mieux rejoindre et de mieux répondre aux besoins des pères issus de l’immigration.
Ce bilan présente une synthèse des principaux résultats obtenus dans le cadre de ce projet qui a été mené dans le Grand Montréal entre octobre 2020 et avril 2022.

We sought to determine the association between SES and glycemic control in children with type 1 diabetes (T1D) followed at the Montreal Children’s Hospital (MCH), and whether insulin pump use, processes of care and depression modified the association. Using MCH’s Pediatric Diabetes Database, we conducted a retrospective cohort study of children ages 0 to 18 years diagnosed with T1D for at least a year with a visit between November 2019 and October 2020. Our outcome was mean glycated hemoglobin (HbA1c) in the following year. Our main exposure was socioeconomic status (SES; least deprived, moderately deprived, most deprived) measured by the Material and Social Deprivation Index. We used multivariable linear regression to determine the association between SES and HbA1c, adjusting for age, sex, diabetes duration, insulin pump use and processes of care. Interaction terms for insulin pump, processes of care and depression were included. A total of 306 children were identified. Children in the most deprived quintiles had higher mean HbA1c compared to those in the least deprived quintiles (p<0.01). HbA1c in the most deprived quintiles was 0.5% higher compared to the least deprived quintiles (95% confidence interval, 0.14 to 0.86). Effect modification by insulin pump, processes of care and depression was not significant. Consistent with previous findings, lower SES was associated with higher HbA1c. Our results are important for further research to understand contributing factors to these disparities.

La pandémie de maladie à coronavirus 2019 (COVID-19) a exacerbé les inégalités sociales dans les aspects ethniques, raciaux et socio-économiques, avec d’importantes conséquences nocives pour les enfants. En s’appuyant sur les leçons tirées des initiatives communautaires, le présent commentaire propose une réflexion sur les défis de l’équité, de la diversité et de l’inclusion qui sont intégrés dans les campagnes de vaccination des enfants dans un contexte d’urgence. Nous sommes d’avis que la mise en place de pratiques équitables et inclusives liées à la vaccination des enfants des communautés marginalisées est un défi à multiples facettes. Au-delà des bonnes intentions (vouloir protéger les enfants), les risques et les avantages associés à la mise en évidence de la diversité dans chaque intervention doivent être soigneusement examinés, surtout en ce qui concerne une procédure contestée ou polarisée, comme la vaccination avec un nouveau type de vaccin. Souvent, une approche unique réfute et perpétue les inégalités structurelles. Dans d’autres cas, la mise en évidence de la diversité et des inégalités peut par inadvertance accroître la stigmatisation et la discrimination, et nuire davantage ou infantiliser les collectivités ciblées. En offrant des perspectives multiples, une approche transdisciplinaire peut appuyer la prise de décision dans un contexte de crise.

Mots-clés : santé et médecine des adolescents, services de santé communautaires, santé des minorités, équité et inclusion

Keywords: Quality Lessons Learned (QLLs); Quebec; Hospitals’ Resilience; COVID-19 pandemic project

Abstract

Background

Refugees, asylum seekers, and migrants without status experience precarious living and working conditions which disproportionately expose them to COVID-19. In the two most populous Canadian provinces (Quebec and Ontario), to reduce the vulnerability factors experienced by the most marginalized migrants, the public and community sectors engage in joint coordination efforts called intersectoral collaboration. This collaboration ensures holistic care provisioning, inclusive of psychosocial support, assistance to address food security, as well as educational and employment assistance. This research project explores how community and public sectors collaborated on intersectoral initiatives during the COVID-19 pandemic to support refugees, asylum seekers, and migrants without status in cities of Montreal, Sherbrooke, and Toronto, and generates lessons for a sustainable response to the heterogeneous needs of these migrants.

Methods

This theory-informed participatory research is co-created with socio-culturally diverse research partners (refugees, asylum seekers and migrants without status, employees of community organizations, and employees of public organizations). We will utilize Mirzoev and Kane’s framework on health systems’ responsiveness to guide the 4-phases of a qualitative multiple case study (a case being an intersectoral initiative). These phases will include, 1) building an inventory of intersectoral initiatives developed during the pandemic, 2) organizing a deliberative workshop with representatives of the study population, community and public sectors respondents to select and validate the intersectoral initiatives, 3) interviews (n = 80) with community and public sector frontline workers and managers, municipal/regional/provincial policymakers and employees of philanthropic foundations 4) focus groups (n = 80) with refugees, asylum seekers, and migrants without status. Qualitative data will be analyzed using thematic analysis. The findings will be used to develop discussion forums to spur cross-learning among service providers.

Discussion

This research will highlight the experiences of community and public organizations in their ability to offer responsive services for refugees, asylum seekers, and migrants without status in the context of a pandemic. We will draw lessons learnt from the promising practices developed in the context of COVID-19, to improve services beyond times of crisis. Lastly, we will reflect upon our participatory approach – particularly in relation to the engagement of refugees and asylum seekers in the governance of our research.

Introduction

UNICEF estimates that there are as many as 100 million street-involved youth (SIY) globally. Marginalized conditions put SIY at higher risk of HIV and adverse outcomes once HIV-positive. The objective of this analysis was to describe barriers and facilitators of accessing HIV prevention, testing, and treatment services as Phase I of an implementation study evaluating the use of peer navigators to increase access to HIV services.

Methods

Semi-structured interviews, focus group discussions (FGD), and theatre testing were conducted with individuals who identify as SIY, health care providers, and community stakeholders living in Canada (Toronto, Montreal, London) and Kenya (Eldoret, Huruma, Kitale). Data were analyzed using a directed content approach, guided by the socio-ecological model (SEM).

Results

Across the six sites were 195 participants: 64 SIY, 42 healthcare providers, and 97 community-based stakeholders. Barriers were identified at the societal (e.g. intersectional stigma and discrimination), public policy (e.g., inadequate access to basic needs, legal documentation, lack of health insurance, and limited community-based funding), institutional (e.g. lack of inclusive education and training, inadequate HIV educational outreach, and restrictive service provision), interpersonal (e.g., ineffective communication from healthcare providers), and intrapersonal levels (e.g. lack of trust and associated fear, low perception for healthcare, and lack of self-esteem). These contributed to limited HIV services utilization among SIY. Conversely, numerous facilitators were also identified at the public policy (e.g. affordable HIV services and treatment), institutional (e.g. available and accessible HIV prevention tools, HIV education and awareness programs, and holistic models of care), interpersonal level (e.g., systems navigation support, peer support, and personal relationships), and intrapersonal levels (e.g. self-efficacy) as positively supporting SIY access to HIV services.

Conclusion

Intersectional stigma was a critical barrier in all sites, and policies and programs that foster welcoming environments for youth from diverse backgrounds and living circumstances may be better able to respond to the HIV service needs of this high risk population. Social support and navigation services were reported to facilitate access to HIV services in all sites.

The rise of various forms of violent radicalization challenges both the political and psychosocial realms. In response, various prevention programs are being developed, notably based on risk and protective factors identified in the literature on violent radicalization. This article examines these factors and questions the possible relevance of art-centered approaches in preventing violent radicalization. Questions raised by a recent pilot project carried out with young people attracted by violent radicalization and monitoring their engagement in artistic activities served as a starting point for reflection. This work will highlight certain issues surrounding the use of art as an alternative outlet to violence by focusing particularly on the conditions under which this recourse can be meaningful.

L’implantation de réseaux de services intégrés jeunesse (RSIJ) au Québec et ailleurs dans le monde témoigne de la volonté des décideurs de répondre de façon efficace aux problématiques de santé globale des jeunes de 12 à 25 ans. Cette évaluation a eu pour objectif d’analyser le contexte de mise en œuvre et l’efficacité de ce modèle. Les questions d’évaluation s’articulaient autour des facilitateurs et des obstacles à la mise en œuvre d’un RSIJ; son efficacité (sur le plan de l’amélioration de l’état de santé et du bienêtre des jeunes et de leur trajectoire) et de son efficience (coûts-avantages, coûts-efficacité; coûts-utilité). L’évaluation s’intéressait également aux variations éventuelles de la mise en œuvre et de l’efficacité dans le cas où les services sont offerts à des jeunes de la diversité ethnoculturelle. Cinq réseaux de services intégrés à l’international ont été étudiés (headspace, Australie; Youth One-Stop Shop, Nouvelle-Zélande; Jigsaw, Irlande; Foundry, Canada; Prépsy, France). La revue de la littérature systématique a permis, entre autres, d’identifier neuf (9) composantes clés dans la mise en œuvre et la prestation des services dans les RSIJ qui ont été validées en consultation avec les jeunes et des intervenants.

This is the protocol for a Campbell systematic review. The main objective of this project is to gather, critically appraise, and synthesize evidence about the appropriateness and utility of tools used to assess the risk of violent radicalization.