Engaging peer-interviewers in qualitative inquiry is becoming more popular. Yet, there are differing opinions as to whether this practice improves the research process or is prohibitively challenging. Benefits noted in the literature are improved awareness/acceptance of disenfranchised groups, improved quality of research, and increased comfort of participants in the research process. Challenges include larger investment in time and money to hire, train, and support peerinterviewers, and the potential to disrupt peer recovery. We illustrate, through case study, how to engage peer-interviewers, meet potential challenges, and the benefits of such engagement. We draw upon our experience from a qualitative study designed to understand men's experiences of problem gambling and housing instability. We hired three peers to conduct semi-structured qualitative interviews with 30 men from a community-based organization. We contend, that with appropriate and adequate resources (time, financial investment), peer-interviewing produces a positive, capacity building experience for peer-interviewers, participants and researchers.

Few studies have examined the prevalence of problem and pathological gambling among clients of homeless service agencies. The objective of this study was to estimate the prevalence of problem gambling among these clients. We collected primary data on gambling using the NORC diagnostic screen for disorders. Using a modified time-location recruitment approach 264 clients of a community homeless service agency were screened for lifetime gambling problems. Descriptive statistics were produced using SPSSX. The prevalence of lifetime problem gambling was 10 % and that of pathological gambling was 25 % in this sample. The prevalence of lifetime problem and pathological gambling was alarmingly high relative to the general population lifetime prevalence. Better insight into interventions for gambling that might reduce risk of homelessness will help service agencies gauge the needs of their clients and to implement change to service delivery and screening practices.

BackgroundPatients and caregivers often face significant challenges when they are discharged home from hospital. We sought to understand what influenced patient and caregiver experience in the transition from hospital to home and which of these aspects they prioritised for health system improvement.MethodsWe conducted group concept mapping over 11 months with patients—and their caregivers—who were admitted to a hospital overnight in the last 3 years in Ontario, Canada and discharged home. Home included supportive housing, shelters and long-term care. Participants responded to a single focal prompt about what affected their experience during the transition. We summarised responses in unique statements. We then recruited participants to rate each statement on a five-point scale on whether addressing this gap should be a priority for the health system. The provincial quality agency recruited participants in partnership with patient, community and healthcare organisations. Participation was online, in-person or virtual.Results736 participants provided 2704 responses to the focal prompt. Unique concepts were summarised in 52 statements that were then rated by 271 participants. Participants rated the following three statements most highly as a gap that should be a priority for the health system to address (in rank order): ‘Not enough publicly funded home care services to meet the need’, ‘Home care support is not in place when arriving home from hospital’ and ‘Having to advocate to get enough home care’. The top priority was consistent across multiple subgroups.ConclusionsIn a country with universal health insurance, patients and caregivers from diverse backgrounds consistently prioritised insufficient public coverage for home care services as a gap the health system should address to improve the transition from hospital to home.

IntroductionLanguage interpretation services for patients who are not proficient in a country’s official language(s) are essential for improving health equity across diverse populations, and achieving clinical safety and quality for both patients and providers. Nevertheless, overall use of these services remains low, regardless of how they are delivered. In Toronto, Ontario, one of the most ethnically diverse urban centres, the regional local health integration network which oversees the highest concentration of health care organizations servicing 1.2 million residents, partnered with key stakeholders to make Over-the-Phone (OPI) interpretation services broadly and economically available in 170 different languages to its diverse network of health care organizations. This evaluation aimed to assess patients’ and providers’ experiences with OPI in these varied settings and the impact (if any) on alternative interpretation services and on health service delivery access and quality.MethodsThis study used a two-phased sequential exploratory mixed-methods approach to evaluate the initiative. Phase I was comprised of semi-structured interviews with representatives from the program stakeholders; these findings were applied to identify appropriate survey questions and response categories, and provided context and depth of understanding to Phase II results. Phase II included web-based and self-administered surveys for both providers and patients engaging with OPI.ResultsBoth providers and patients identified a broad range of positive impacts OPI had on health care service delivery quality and access, and high levels of satisfaction with OPI, in a variety of health care settings. Providers also revealed a marked decrease in the use of ad-hoc, nonprofessional strategies for interpretation after the implementation of OPI, and noted it had either no impact on their workload or had decreased it overall.ConclusionsOPI is clearly not the sole answer to the complex array of health care needs and access gaps that exist for persons without proficiency in their country’s official language. Nevertheless, this evaluation provides compelling evidence that OPI is a valuable component, and that it may contribute to a broader range of positive impacts, and within a broader range of health care settings, than previously explored.

CMAJ OPEN, 8(1) E121 Plain language summary: Transitioning back home after a hospital admission can be a tricky time for patients and their caregivers.Patients have experienced changes in their health and ability to function independently, and, at the same time, are relying on different parts of the health care system to work well together. We wanted to understand what most affected patient and caregiver experience in the transition from hospital to home and use our findings to develop a provincial quality standard that outlines what good care looks like when patients are discharged from hospital to home. We conducted public outreach over 10 weeks beginning Jan. 11, 2018 to recruit patients and caregivers who had a lived experience transitioning from hospital to home in Ontario in the previous 3 years. We asked participants to brainstorm responses to a single question: "When leaving the hospital for home, some thing(s) that affected the experience were: ____." A total of 665 patients and caregivers responded to the question online, and another 71 via a facilitated group discussion. We analyzed the data for themes and found that patients and caregivers identified 6 key areas affecting their experience transitioning from hospital to home: home and community care, the discharge process, medical follow-up after discharge, medications, patient and caregiver education, and the kindness and caring of the health care team in hospital. The most common challenges were with the timeliness, sufficiency, reliability and consistency of publicly funded home care services. Understanding what matters to patients and caregivers helps us define what good care looks like and how we should focus efforts to improve our health care system.Background: Improving the quality of care for patients who return home after a hospital stay is an international priority; however, few jurisdictions have engaged broadly with patients and caregivers to understand what most affects their experience transitioning home. We performed Ontario-wide group concept mapping, beginning with a brainstorming phase, to understand patient and caregiver priorities in the transition. Methods:We used group concept mapping to engage patients and caregivers who had lived experience transitioning from hospital to home in Ontario in the previous 3 years. We report on the first phase, brainstorming, conducted over 10 weeks beginning Jan. 11, 2018 via an online survey or facilitated group discussion. Participants responded to a single focal prompt: "When leaving the hospital for home, some thing(s) that affected the experience were: ____." The study team identified recurrent concepts and overarching themes. Patients and caregivers informed the study design, recruitment and data interpretation. Results:In all, 665 people (263 patients [39.5%], 352 caregivers [52.9%] and 50 people who were both patient and caregiver [7.5%]) participated in brainstorming online, and 71 people participated in 1 of 8 group discussions. Participants identified 6 key areas affecting their experien...

The participation of persons with disabilities in society continues to be limited by negative attitudes. Media reporting has a significant influence on public attitudes toward disability. In a content analysis of three Canadian newspapers, this study found several significant changes in the language and content of disability-related articles. Together, these changes provide some evidence of more favorable media representations of disability. Further research in rehabilitation is needed to understand how such changes may both reflect and facilitate ongoing efforts to enhance people with disabilties' participation in social life.

Cervical cancer remains a global public health concern, even though scientific advancements have made the disease almost entirely preventable. With the link between human papillomavirus (HPV) and cervical cancer, and the subsequent improvement in screening technology, there is potential to improve access and coverage of cervical screening with the introduction of HPV self-sampling. In Ontario, Canada, a province with a cytology-based screening program (i.e., Pap test), women who identify as South Asian, West Asian, Middle Eastern and North African have some of the lowest rates of screening, and research suggests they have a higher burden of cervical cancer. In this study, we will use both quantitative and qualitative methods to understand the acceptability and uptake of a take-home HPV self-sampling kit. Working with community champions—people with pre-existing connections with local groups—we will recruit women from these groups who are under- or never-screened for cervical cancer. Women will self-select whether they are in the group that tries HPV self-sampling or in the group that does not. We will aim for 100 women in each group. All participants will provide feedback on the feasibility, acceptability and preferences for cervical screening through a survey and phone follow-up. Women who self-select the HPV self-sampling group, will be followed up to find out if they followed through with self-sampling and to understand their experience using the device. Women who do not want to try self-sampling will be followed up to see if they went on to get a Pap test. The qualitative phase of this study consists of five focus groups with participants and semi-structured interviews with key informants in the community.

Primary care physicians play an important role in care coordination, including initiating referrals to community resources. Yet, it is unclear how awareness and use of community resources vary between physicians practising with and without an extended healthcare team. We conducted a cross-sectional survey of primary care physicians practising in Toronto, Canada, to compare awareness and use of community services between physicians practising in team-and non-team-based practice models. Team-based models included Community Health Centres and Family Health Teams -settings in which the government provides funding for the practice to hire non-physician health professionals, such as social workers, pharmacists, nurse practitioners, registered nurses and others. The survey was mailed to physicians, and reminders were done by phone, fax and e-mail. We used logistic regression to compare awareness between physicians in team-based (N = 89) and non-team-based (N = 138) models after controlling for confounders. We found that fewer than half of the physicians were aware of five of eight centralized intake services (e.g., ConnexOntario, Telehomecare). For most services, team-based physicians had at least twice the odds of being aware of the service compared to non-team-based physicians. Our findings suggest that patients in team-based practices may be doubly advantaged, with access to non-physician health professionals within the practice as well as to physicians who are more aware of community resources. RésuméLes médecins de première ligne jouent un rôle important dans la coordination des soins, notamment en aiguillant des patients vers les ressources communautaires. Toutefois, on ne sait à quel point le degré de connaissance et l' utilisation des ressources communautaires varient entre, d' une part, les médecins qui exercent leur pratique au sein d' une équipe de soins multidisciplinaire et, d' autre part, ceux qui exercent leur pratique en dehors de tels équipes. Nous avons mené une enquête intersectorielle auprès des médecins de première ligne qui oeuvrent à Toronto, en Ontario, afin de comparer le degré de connaissance et l' utilisation des services communautaires entre les deux modèles de pratique. Les modèles d'équipes comprennent les centres de santé communautaire et les équipes Santé familiale -des organismes dont le gouvernement finance le recrutement de professionnels de la santé non médecins tels que les travailleurs sociaux, les pharmaciens, les infirmières praticiennes, les infirmières autorisée et autres. L' enquête a été envoyée par la poste aux médecins, puis a fait l' objet de rappels par téléphone, par télécopie et par courriel. Nous avons employé la régression logistique pour comparer le degré de connaissance des ressources communautaires entre les médecins qui travaillent au sein d'équipes (N = 89) et ceux qui travaillent en dehors de ces équipes (N = 138), après contrôle des facteurs de confusion. Nous avons observé que moins de la moitié des médecins avaient connaissance de cinq des huit points d' accès...