Background Research on public health responses to COVID-19 globally has largely focused on understanding the virus’ epidemiology, identifying interventions to curb transmission, and assessing the impact of interventions on outcomes. Only recently have studies begun to situate their findings within the institutional, political, or organizational contexts of jurisdictions. Within British Columbia (BC), Canada, the COVID-19 response in early 2020 was deemed highly coordinated and effective overall; however, little is understood as to how these upstream factors influenced policy decisions. Methods Using a conceptual framework we developed, we are conducting a multidisciplinary jurisdictional case study to explore the influence of institutional (I), political (P), organizational (O), and governance (G) factors on BC’s COVID-19 public health response in 2020–2021. A document review (e.g. policy documents, media reports) is being used to (1) characterize relevant institutional and political factors in BC, (2) identify key policy decisions in BC’s epidemic progression, (3) create an organizational map of BC’s public health system structure, and (4) identify key informants for interviews. Quantitative data (e.g. COVID-19 case, hospitalization, death counts) from publicly accessible sources will be used to construct BC’s epidemic curve. Key informant interviews (n = 15–20) will explore governance processes in the COVID-19 response and triangulate data from prior procedures. Qualitative data will be analysed using a hybrid deductive–inductive coding approach and framework analysis. By integrating all of the data streams, our aim is to explore decision-making processes, identify how IPOG factors influenced policy decisions, and underscore implications for decision-making in public health crises in the BC context and elsewhere. Knowledge users within the jurisdiction will be consulted to construct recommendations for future planning and preparedness. Discussion As the COVID-19 pandemic evolves, governments have initiated retrospective examinations of their policies to identify lessons learned. Our conceptual framework articulates how interrelations between IPOG contextual factors might be applied to such analysis. Through this jurisdictional case study, we aim to contribute findings to strengthen governmental responses and improve preparedness for future health crises. This protocol can be adapted to and applied in other jurisdictions, across subnational jurisdictions, and internationally.
Background: Infancy appears to be a critical period for establishing a person's weight set point. It remains unclear which interventions during infancy may be most effective in preventing later obesity and which ones are most acceptable to parents. The aim of this study was to examine the attitudes of parents of children aged 2 years and under toward different obesity prevention messages and their preferences with regard to these messages. Methods: Using a qualitative research design, we conducted semistructured interviews followed by a focus group. Parents of children under 2 years of age were purposively recruited from 2 communities in British Columbia, Canada, and asked for their opinions about various health promotion messages relating to obesity prevention. A theoretical thematic analysis was used to analyze the data. Results: Thirty-three parents participated in the study. Participants reported that many of the current recommendations (no screen time, no sugary beverages) are unrealistic, unclear and inconsistent, making them difficult to follow and causing parents to feel guilty; they had a more positive response to the feeding roles message. Parents noted the importance of starting education early and targeting the broader community. Interpretation: Several important and interesting themes were identified in this study, which increases our understanding of parents' attitudes toward and preferences for the messages presented. Obesity prevention information for today's busy parents needs to be realistic, supportive and timely.
Background/Objective: Diabetes-related conflict between caregiver and child has been associated with lower quality of life, reduced treatment adherence, and higher hemoglobin A1C. The objective of this project was to identify patient and family characteristics associated with higher levels of diabetes-specific family conflict. Methods: This was a cross-sectional study. Caregivers of children aged 4-to 18-years-old with type 1 diabetes were recruited from diabetes clinics across British Columbia. Data were collected through chart reviews and patient surveys, including the Diabetes Family Conflict Scale and the Adherence in Diabetes Questionnaire. All caregivers and children ≥8-years-old were invited to complete the survey. Potential predictors were explored using univariate and multivariable linear regression models. Results: In the unadjusted analysis, higher caregiver report of conflict (n = 196) was associated with: low family income, non-Caucasian ethnicity, missed school, older age at diagnosis, and insulin regimen (2-3 injections/day rather than multiple daily injections or pump). When all variables were adjusted for simultaneously, income, insulin regimen, one or more stay at home parent and recent hospitalization were significant. For the child report (n = 111), higher maternal education was associated with lower conflict in the unadjusted analysis and non-Caucasian ethnicity was associated with higher conflict in the adjusted analysis. Conclusions: This exploratory study identified possible novel associations between patient and family characteristics and diabetes-related family conflict.
In recent years, the literature on public health interventions and health outcomes in the context of epidemic and pandemic response has grown immensely. However, relatively few of these studies have situated their findings within the institutional, political, organizational, and governmental (IPOG) context in which interventions and outcomes exist. This conceptual mapping scoping study synthesized the published literature on the impact of IPOG factors on epidemic and pandemic response and critically examined definitions and uses of the terms IPOG in this literature. This research involved a comprehensive search of four databases across the social, health, and biomedical sciences as well as multi-level eligibility screening conducted by two independent reviewers. Data on the temporal, geographic, and topical range of studies were extracted, then descriptive statistics were calculated to summarize these data. Hybrid inductive and deductive qualitative analysis of the full-text articles was conducted to critically analyze the definitions and uses of these terms in the literature. The searches retrieved 4,918 distinct articles; 65 met the inclusion criteria and were thus reviewed. These articles were published from 2004 to 2022, were mostly written about COVID-19 (61.5%), and most frequently engaged with the concept of governance (36.9%) in relation to epidemic and pandemic response. Emergent themes related to the variable use of the investigated terms, the significant increase in relevant literature published amidst the COVID-19 pandemic, as well as a lack of consistent definitions used across all four terms: institutions, politics, organizations, and governance. This study revealed opportunities for health systems researchers to further engage in interdisciplinary work with fields such as law and political science, to become more forthright in defining factors which shape responses to epidemics and pandemics, and to develop greater consistency in using these IPOG terms in order to lessen confusion among a rapidly growing body of literature.
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