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Title: Exploring the use of emergency health services for stroke
Contributors: Damanpreet K. Kandola (author), Davina Banner-Lukaris (thesis advisor), Todd Whitcombe (chair), Chelsea Pelletier (committee member), Shannon Freeman (committee member), David Snadden (committee member), Pam Ramsay (committee member), Theresa Green (committee member), University of Northern British Columbia Health Sciences (Degree granting institution)
Abstract: Transport practices for seeking emergency stroke care remain largely underresearched and poorly understood, particularly for individuals living in small urban, rural, and remote regions. This multi-method study aims to address this knowledge gap and explores the impact of mode of transport on in-hospital stroke care and the decision-making process of seeking emergency medical attention for patients and their caregivers. Data from the Discharge Abstract Database provide information on stroke-related use of emergency health services across British Columbia. Data from the Canadian Institutes for Health Information Special Project 340 provide information on if calling emergency health services impacts the delivery of care, including the completion of neuroimaging, the administration of acute thrombolysis, and the prescription of antithrombotics upon discharge across a northern health region. Focused, semi-structured interviews provide contextual insight into the decision-making processes for seeking emergency stroke care among patient and caregiver participants in a northern health region. Stroke-related emergency health service use across British Columbia from January 2015 to March 2018 was 67.9% (N=19,849), ranging from 58.8% in Northern Health to 70.2% in Fraser Health. In Northern Health (N=784), there were differences between health service delivery areas for stroke-related emergency health service use ranging from 53.7% in the Northwest to 64.8% in the Northern Interior from January 2015 to March 2018. Similar differences in thrombolytic therapy administration and the prescription of antithrombotics were noted. The odds of emergency health service use were greater for those 65 years of age and older than those younger than 65 and lower for those in the Northwest health service delivery area than those in the Northern Interior health service delivery area. Differences were found for the completion of neuroimaging between males and females. Interviews for patient (n=12) and caregiver (n=7) participants provide complementary contextual insights and yielded three key themes, including the decision-making process following a stroke, experiences of care, and perceived gaps and areas in need of further support. This integrated knowledge translation-informed and practice-driven research addresses health services and policy priorities. Findings are anticipated to help inform the development and refinement of emergency health services in British Columbia by highlighting differences in emergency health services use across geographies and identifying factors that inform patient decisionmaking when seeking emergency medical attention.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2021

Title: Examining the climate for Aboriginal mothers in neonatal intensive care units (NICUs): an exploratory qualitative study about views of health care professionals
Contributors: Minette Marcotte (author), Arthur Fredeen (Thesis advisor), Sarah de Leeuw (Thesis advisor), University of Northern British Columbia College of Science and Management (Degree granting institution), Lela Zimmer (Committee member), Vincent Arockiasamy (Committee member)
Abstract: This thesis presents a qualitative exploratory ethnographic study that examines views of a small number of health care professionals towards Aboriginal mothers at risk for child apprehension within two neonatal intensive care units (NICUs) in two different hospitals. This research investigates the question “what are the views and feelings of various health care professionals towards Aboriginal mothers in the NICU, and, in conjunction with various social discourses, how (or do) those views and feelings possibly affect apprehension outcomes in the NICU?” ...
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2017

Title: ‘Experience talks, resilience shapes’ revisiting historic trauma: impact on treatment in indigenous males living with HIV/AIDS in British Columbia
Contributors: Meck Chongo (author), Henry Harder (thesis advisor), Josée Lavoie (thesis advisor), Eric A. Roth (committee member), Robert Hogg (committee member), University of Northern British Columbia College of Arts, Social and Health Sciences (Degree granting institution)
Abstract: There is an over-representation of HIV incidence, prevalence and mortality rates in the Indigenous population of Canada. Further, many do not adhere to HAART partly because of unresolved historic trauma (HT). Most research on HIV/AIDS therapy has focused on “maladaptive” characteristics of Aboriginal males and less on their adaptive, life-maintaining practices. This study explored the impact of HT on treatment among Indigenous males living with HIV/AIDS in BC, with a focus on adaptive/life maintaining practices, i.e., how the experience of HT positively affects male survivors’ ability to adhere to treatment, and the HT impact on treatment outcomes across age groups and residential school survivor status. Using interpretive description incorporating a cultural safety lens as the methodological framework, data was collected through one-to-one interviews, a focus group, and a few Life Story Board sessions. Thirty-six HT survivors told their lived experience stories, discussed how HT affected their adherence to HAART, and explained how they build resilience. Three main themes resulted from data analysis: 1) facilitators of choice or actions leading to HAART adherence; 2) factors leading to HAART non-adherence; and 3) comparative survivor responses on health, services, stigma and the historic trauma effect. Adherence choices and actions are promoted by psychological support, cultural services, religion and spirituality, structural services, resilience, strictness and discipline metered on indirect survivors through their parents. Negative choice or actions resulted from; personal reasons, cultural restrictiveness, lack of structural support and services, spiritual and religion-related factors, and intergenerational historic trauma effects. Finally, comparative responses of survivors’ views noted included the view of health with respect to resilience, availability of and access to services on-and off-reserve, stigma and confidentiality, and the effect of historic trauma through generations and across survivor status. The findings demonstrate how complex the experience and expression of HT is and that most Indigenous men can be resilient to stay on HAART and have better health and wellbeing. Cultural-safety informed recommendations are offered to better address HT, improve treatment-adherent behaviour and resilience, foster healing and reduce deaths due to HIV/AIDS. This study suggests promising resilience factors that have implications for both research and practice.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2017

Title: A pivotal time in global cervical cancer prevention
Contributors: Virginia Lynn (author), Henry Harder (thesis advisor), Gina Ogilvie (thesis advisor), Sheona Mitchell-Foster (committee member), Angela Kaida (committee member), Josée Lavoie (committee member), University of Northern British Columbia (Degree granting institution)
Abstract: It is a pivotal time in cervical cancer prevention for young South African (SA) women. Cervical cancer and infection with human immunodeficiency virus are both major public health concerns in SA. This study describes knowledge of female adolescents and young adults (AYA) about HPV, cervical cancer and explores predictors of HPV vaccine and HPV self-sample testing acceptability. In this cross-sectional study, questionnaires were administered to 122 female AYA who involved in a longitudinal study (AYAZAZI) which examined risk factors involved with HIV acquisition. Results indicated that although awareness and knowledge about these topics was very low among participants, as were perceptions of risk of acquiring HPV and developing cervical cancer, acceptability was very high towards HPV vaccines for self (97%) and (future) children (95%), as well for self-sample testing (85%). No significant variables were found to be associated with risk perception or self-sample acceptance. A significant difference was found between participants’ perceived risk of acquiring HPV, HIV, and developing cervical cancer compared to the risk they felt other female AYA in their communities were at. The most influential sexual and reproductive health (SRH) information source and significant influences on HPV vaccine recommendations for participants were health care providers. Findings from this study are important in designing effective cervical cancer control programs that can attract more AYA for HPV vaccines and screening. As the HPV vaccine has only recently been introduced at a national level in SA, this study about awareness and vaccine acceptability is timely.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2018

Title: ‘Niit nüüyu gwa’a
Contributors: Jessie King (author), Henry Harder (thesis advisor), Linda O'Neill (committee member), Tina Fraser (committee member), Josee Lavolie (committee member)
Abstract: Hadiksm Gaax di waayu, I belong to the Ganhada (Raven Clan) and my Mother’s side of the family is from Gitxaala, we follow our Mothers. This research, writing, and data collection was done on the traditional unceded territories of the Tsimshian, Lheidli T’enneh, and Musqueam. This work was done in partnership with the people who shared their stories with me, the co-researchers, whose words provide a brief glimpse into the lived experience of First Nations identity and the thought processes involved in contemplating several sources of input informing how we think about identity. Stories of identity, perceptions of identity, and experiences of racism and discrimination have inspired this work and highlighted the need for engagement. This research is a validation of thought processes that surround how we, First Nations people, experience identity. A shift away from Western conceptualizations of identity, this research discusses experiential knowledge, racism and discrimination, impacts of racial microaggressions on self-perceptions and health, and a sampling of how some people have come to define their identity in their own way based on their experiences. The intent of this work is to both inform those who may not understand and to acknowledge and validate those who have thought about First Nations identity but do not have a safe space to share. I hope this work speaks to both First Nations and non-First Nations/Settler Canadians as we continue learning about one another and sharing with each other in the spirit of reconciliation.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2019

Title: Addressing uncertainty : contributions of knowing patients and team members to negotiating team-based primary care
Contributors: Erin Wilson (author), Martha MacLeod (thesis advisor), Neil Hanlon (committee member), David Snadden (committee member), Brenda Cameron (committee member), University of Northern British Columbia (Degree granting institution)
Abstract: The interprofessional team-based primary care model currently being implemented in northern British Columbia represents a significant shift in primary care delivery. The purpose of this study is to examine how patients feel known in the context of an interprofessional primary care team that is not co-located, and to illuminate how practices of connection between patients, providers, and team members can influence how care is negotiated within the team. Through methods of observation and interviews, data were collected then analyzed interpretively. The findings of this study highlight practices within patient-provider encounters that contribute to patients feeling known and maintain therapeutic relationship. The way in which primary care providers know patients influences decision-making about which patients need team-based care, and when. The relationship between primary care providers and team members is also influential in deciding who needs team-based care, yet existing relationships can be disrupted by the degree of uncertainty that occurs alongside major shifts in primary care delivery. Team-based primary care is negotiated through practices of connection and genuine conversation. These practices and conversations influence the timing of team involvement, the information that is shared, and the type of care that is provided. Implications of these findings can support efforts to increase relationship-based care for patients and improve understanding about what patients value in receiving team-based care. Engaging in practices of connection and genuine conversation helps relieve uncertainty, whether at a team or patient level, and re-aligns the core attributes of primary care as central to delivering high quality team-based care.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2017

Title: "Like being pecked to death by a chicken"
Contributors: Shirley Giroux (author), Andrew Kitchenham (thesis advisor), University of Northern British Columbia College of Arts, Social, and Health Sciences (Degree granting institution), Shannon Wagner (committee member), John Sherry (committee member), Kathryn Banks (committee member)
Abstract: Teachers are helping professionals for whom caring work is a significant aspect of the job. Conflicts between work and family demands arise from various antecedent work, home, and personal features and have been linked to negative effects on mental health and quality of life, as well as increased rates of burnout. This research investigated whether mothers and non-mothers differ in their reported experiences of wellness at work and home. Using teachers as a proxy for helping professionals, this research used mixed methods to explore whether there might be observable differences between the experiences of women who are parents with children at home, compared to those who are child-free. A sample of British Columbia teachers (n = 182) was surveyed to seek quantifiable within-profession differences in measures of stress, work/life conflicts, and/or resilience between groups of K–12 teachers, based on whether or not they had children at home. These surveys also provided opportunities for participants to share stories of challenging experiences and the resilience strategies they used to work through them. A subsample of the survey group of teacher/mothers analyzed and made sense of the collected stories in light of the quantitative results and their own experiences as part of the process of Participatory Narrative Inquiry (PNI), which comprised the qualitative portion of this research and resulted in suggestions of many strategies. Statistically, it appears parent and non-parent teachers may differ only in the greater extent to which the former report family demands to interfere with the time and effort they can spend at or on work. In general, teachers reported similar challenges regardless of whether they were mothers and may use similar resilience strategies (such as self-efficacy) to support them in their caring work. Formal elucidation of these strategies may facilitate the translation of this research into meaningful supports and strategies to facilitate equilibrium between work and home for all helping professionals.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2019

Title: Firefighters, hostility, and satisfaction with life, job and marital relationship
Contributors: Romana Pasca (author), Shannon Wagner (thesis advisor), Paul Siakaluk (committee member), R. Luke Harris (committee member), University of Northern British Columbia (Degree granting institution)
Abstract: Hostility is associated with negative health outcomes. Empirical research has indicated that high levels of hostility, in association with personal characteristics, may result in either aggressive actions and re-actions, or isolation and disengagement. The purpose of this study was to investigate hostility and its influence on mental health, overall satisfaction with life, job, and marital relationship, and cardiovascular health of professional firefighters. The study was analyzed in the context of Social Ecology Theory exploring how personality, spousal relationship, and social factors influenced the relationship between work and health. Firefighters were invited to engage their romantic partners in the study assessing how work stress impacted intimate relationship. Data analyses involved structural equation modeling, as well as repeated measures multivariate analysis of variance and multilinear regressions. The results indicated that work stress and exposure to toxic environment and hazardous conditions have a negative impact on the mental health and overall satisfaction of firefighters, but not on hostility. When controlling for personality, openness to experience revealed a significant relationship between work and hostility. No significant relationships were observed either between hostility and domestic conflict or between hostility and cardiovascular health.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2018

Title: Incorporating business process management, business ontology and business architecture in medication management quality
Contributors: Bonnie Sue Urquhart (author), Waqar Haque (thesis advisor), Henry Harder (committee member), Balbinder Deo (committee member), Craig Mitton (committee member), University of Northern British Columbia (Degree granting institution)
Abstract: Managers and care providers in the health sector are expected to deliver safe, efficient and effective services within a resource constrained, complex system. Services are provided through execution of multiple processes. Healthcare organizations tend to be structured in functional based silos with process improvement efforts often focused on individual processes within the discrete silos. This silo based improvement approach fails to take into account upstream and downstream processes executed and managed in other silos. A patient’s journey will typically include processes from multiple silos and therefore, improvement efforts need to focus on end-to-end processes if the goal is to deliver a positive patient experience. In order to optimize processes in a complex adaptive system like healthcare and to effect meaningful change a combination of management disciplines is required. This research explored the use of Business Process Management (BPM), Business Architecture (BA) and Business Process Management Ontology (BPMO) as a comprehensive, integrated approach to design, redesign, evaluate, improve and monitor the safety, efficiency and effectiveness of medication management processes in a multi-site healthcare organization. The contribution of the research was threefold. First, identified benefits of applying BPM, BPMO and BA to increase organization capacity and improve the end-to-end process of medication management; second, demonstrated the application of an ontology and the business layer of enterprise architecture used in other sectors could be successfully utilized in the healthcare sector; and third, developed a process reference model for medication management processes in acute care and long term care facilities.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2018

Title: Cognitive dissonance in social work - the experiences of social workers who facilitate transracial adoption plans for aboriginal children
Contributors: Susan Burke (author), Glen Schmidt (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: This research study explores the idea of cognitive dissonance in social work, where cognitive dissonance is defined as a state of tension that occurs when a person holds two cognitions (ideas, attitudes, beliefs, behaviours) that are psychologically inconsistent with one another (Tavris & Aronson, 2007). Twenty-one social workers who have worked on teams that facilitate transracial adoption plans for Aboriginal children were interviewed regarding their experiences. Three key questions were explored: 1. Do social workers who facilitate transracial adoption plans for Aboriginal children experience cognitive dissonance and, if so, in what ways? 2. How does that cognitive dissonance impact social workers? 3. In what ways do social workers reconcile a sense of dissonance? The findings from this study suggest that social workers do experience cognitive dissonance, that they are impacted in primarily adverse ways, and that they cognitively reconcile the dissonance to decrease their discomfort/tension. These findings are used to provide suggestions on ways that social workers can reduce dissonance as well as ideas for future research and recommendations for practice. --Leaf i.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2016

Title: Factors affecting hospice care use among long-term care facility residents in Canada
Contributors: Beibei Xiong (author), Shannon Freeman (thesis advisor), University of Northern British Columbia College of Arts, Social, and Health Sciences (Degree granting institution), Davina Banner-Lukaris (committee member), Lina Spirgiene (committee member)
Abstract: Hospice care can improve quality of life for persons nearing end of life. Little is known about hospice care practices in long-term care facilities (LTCFs) in Canada. This thesis included 185,715 residents in LTCFs in Canada in 2015 and followed their death records to 2016 to examine the characteristics of residents who received hospice care and those who did not but may have benefitted from it. Univariate, bivariate and multivariate analyses were used depending on the variable type. Results show the actual use of hospice care in LTCFs is very low in Canada (i.e. less than 3%). Residents who received hospice care had more severe and complex clinical needs than those who did not. Findings suggest several possible barriers to hospice use in the LTCF population including ageism, rurality, and disease diagnoses. Immediate action is needed to provide improved access to, and utilization of, hospice care in LTCFs in Canada.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2019

Title: A cross-sectional analysis of alcohol consumption, sex, and the odds of Alzheimer's disease and other dementias in the community-dwelling Canadian population
Contributors: Jennifer Nicole Tippett (author), Henry Harder (thesis advisor), William McGill (chair), Shannon Wagner (committee member), Sandra Allison (committee member), Davina Banner-Lukaris (committee member), University of Northern British Columbia Health Sciences (Degree granting institution)
Abstract: Background: The prevalence of Alzheimer’s disease (AD) and other dementias is perpetually increasing in Canada and worldwide with the aging baby boomer population. It is, therefore, important to identify risk factors for these major neurocognitive disorders, such as alcohol consumption, to mitigate the future burden on caregivers and the economy. The purpose of this study was to replicate previous research regarding the dose-response relationship between alcohol consumption and the odds of currently having AD or another dementia. The possibility of a sex effect moderating this relationship was also explored. Participants: Data were obtained for respondents to the combined 2015/16 cycles of the Canadian Community Health Survey who were aged 41 years or older at the time of the survey’s conduction (nweighted = 16,715,618). Methods: Logistic regression was used to crossectionally assess the relationship between various time- and frequency-related alcohol consumption exposures to outcome dementia status, while controlling for a number of demographic and risk factor variables. Results: A sex effect was identified for drinking at an average frequency of four to six times per week over the past year (p = 0.019, 95% CI: 0.03, 0.73) where women (ORw = 0.13) were more protected against currently having AD or dementia than men (ORm = 0.89) when compared to alcohol abstainers. Binge drinking two to three times per month (OR = 0.19, p = 0.015, 95% CI: 0.05, 0.73) and more than once per week over the past year (OR = 0.16, p = 0.007, 95% CI: 0.04, 0.61) significantly lessened the odds of currently having AD or dementia when compared against alcohol abstainers. A sex effect was present for those who were classified as very heavy drinkers (♂: 6+ drinks/day, ♀: 4+ drinks/day) over the past week (p = 0.018, 95% CI: 1.14, 39.41) where alcohol was protective against currently having AD or dementia in men (ORm = 0.29) and alcohol was a risk factor for currently having AD or dementia in women (ORw = 2.15) when both were referenced with alcohol abstainers. Conclusions: With the exception of very heavy drinker women, drinking alcohol was associated with a reduced likelihood of currently having AD or dementia and sex effects were identified for drinking at a moderate frequency over the past year and very heavy drinkers. However, these results should be interpreted with caution due to the possibility of selection, sparse data, and abstainer biases as well as misclassification error. The primary implication of this research is to inform future studies that a more thorough exploration of a sex effect influencing the relationship between alcohol consumption and having AD or dementia is warranted.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2020

Title: Understanding the mental health and well-being impacts of natural resource extraction and development : global perspectives and insights from Terrace, BC.
Contributors: Katherine E. Cornish (author), Margot Parkes (thesis advisor), Henry Harder (committee member), Gail Fondahl (committee member), University of Northern British Columbia (Degree granting institution)
Abstract: This research couples a global scale targeted systematic review with the perspectives and experiences of mental health service providers in Terrace, British Columbia. A targeted systematic review was conducted exploring mental health and well-being impacts of resource extraction globally. Findings informed qualitative interviews with mental health service providers in Terrace, BC. Main themes from service providers are systemic issues in health care, poor access to mental health services for children and youth, mental health risk factors, social determinants of health, and industry’s lasting influence and legacy. Synthesis of the findings from the systematic review and interviews with service providers indicates providers concerns aligned with the global literature. A synthesis combines the two phases of research. Insights from this work suggest a greater consideration of the social and mental health impacts of industrial projects is necessary, and there is need for equitable access to mental health resources for all ages.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2020

Title: Quantifying contact force artefact in near infrared spectroscopy
Contributors: Timothy Schwab (author), Luke Harris (thesis advisor), Alex Aravind (thesis advisor), Ian Hartley (chair), Sarah Gray (committee member), Matt Reid (committee member), Andrew Macnab (committee member), University of Northern British Columbia Health Sciences (Degree granting institution)
Abstract: Transcutaneous near infrared spectroscopy (NIRS) of muscle requires coupling between the device and the skin. An unfortunate by-product of this coupling is contact force artefact, where the amount of contact force between the device and the skin affects measurements. Contact force artefact is well known, but largely ignored in most NIRS research. We performed preliminary investigations of contact force artefact to quantify tissue behaviour to inform future NIRS designs. Specifically, we conducted three studies on contact force artefact: (i) an experimental investigation of static load at varied levels of contact force and muscle activation, (ii) an experimental investigation of oscillating load at varied levels of contact force and frequency, and (iii) a Monte Carlo simulation of photon propagation through skin, adipose tissue, and muscle. Our results confirmed that contact force artefact is a confounding factor in NIRS muscle measurements because contact force affects measured hemoglobin concentrations in a manner consistent with muscle contractions. Further, the effects of contact force are not altered by muscle contraction and a likely candidate for the mechanism responsible for contact force artefact is the viscoelastic compression of superficial tissues (skin and adipose) during loading. Simulation data suggests that adipose tissue plays a key role in diffuse reflectance of photons, so any compression of the superficial tissues will affect the reflected signal. Further research is required to fully understand the mechanisms behind contact force artefact, which will, in turn, inform future NIRS device designs.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2021

Title: The space to make mistakes
Contributors: Catharine-Joanne Schiller (author), Martha MacLeod (thesis advisor), Glen Schmidt (committee member), Lela Zimmer (committee member), Lianne Jeffs (committee member), University of Northern British Columbia (Degree granting institution)
Abstract: A medication error committed by a student nurse during a clinical placement often results in the student fearing its potential impact on the patient, unit staff, and the student’s educational journey. Student nurses must navigate two parallel systems during a clinical placement – the educational system and the healthcare system – and there can be confusion about what each requires of the student. Neither of these systems contain clear direction for managing student-committed medication errors and for allocating associated responsibility and accountability. This exploratory mixed methods study examines the process by which responsibility and accountability for a student-committed medication error is allocated and the factors that influence that allocation decision. It describes key features of an ideal allocation process and suggests reasons why the current allocation process often does not meet those requirements. Qualitative data were analyzed through interpretive description and quantitative data were analyzed using descriptive statistics. The results were situated, interpreted, and triangulated within a critical realism philosophical framework. An ideal post-error environment must incorporate a just culture. Since students must navigate both the educational institution and the healthcare facility environments during a clinical placement, a just culture must permeate both. However, students are instead colliding with a post-error environment that they perceive as not meeting key ideals of a just culture: fairness, transparency, minimization of fear, and dedication to learning. Findings of this study can be used to drive change that will better support those who are involved in a post-error process, and decrease the significant inconsistencies that are currently of particular concern.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2020

Title: The role of pituitary adenylate cyclase-activating polypeptide (PACAP) in the ventromedial nucleus and its association with the melanocortin system in regulating adaptive thermogenesis
Contributors: Thecla McMillan (author), Sarah Gray (thesis advisor), Chelsea Pelletier (committee member), Geoff Payne (committee member), University of Northern British Columbia (Degree granting institution)
Abstract: Accumulation of excess white adipose tissue in obesity has detrimental consequences for metabolic health. Activation of thermogenic adipocytes confers beneficial effects on metabolic health and is considered a potential therapeutic target for human obesity. Hormones modulating adaptive thermogenesis include melanocortins and pituitary adenylate cyclase-activating polypeptide (PACAP). In PACAP -/- mice, metabolism and thermogenic capacity in response to cold is impaired. I hypothesized PACAP acts in the ventromedial nucleus of the hypothalamus, upstream of the melanocortin system, to regulate sympathetic stimulation of thermogenesis. To assess this, PACAP +/+ and PACAP -/- mice were cold acclimated to 4°C and given daily injections of a melanocortin receptor agonist, Melanotan II (MTII), for 24 days. The effect of MTII on thermogenesis was examined by physiological, molecular, and histological analyses. Results show MTII partially rescued the impaired thermogenic capacity in PACAP -/- mice as compared to PACAP +/+ mice, providing evidence to support our hypothesis.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2017

Title: The healing experiences of adult survivors of complex trauma
Contributors: Serena George (author), Henry Harder (thesis advisor), Linda O'Neill (committee member), Shannon Wagner (committee member), Sylvia Barton (committee member), University of Northern British Columbia (Degree granting institution)
Abstract: Complex trauma is a critical area to explore in terms of the emotional, physical, psychological, social, and spiritual well-being of survivors. This research explored the personal experiences of 12 adult survivors of childhood trauma by interpreting the meanings they attach to their stories of healing. A three phase analysis approach adapted from the work of Lieblich, Tuval-Mashiach, and Zilber (1998) was carried out. Individual interviews were analyzed following a narrative approach to capture each participant’s perspective and meaning. The themes that emerged from the narratives were organized into ten main categories. Five overarching metathemes occurring across all of the participants’ narratives included: Trauma Effects, Establishing Safety, Reclaiming Self, Healing through Relationships, The Healing Journey. The results of this study add important findings that increase understanding of how to address complex trauma in counselling and health care settings in order to restore individual’s sense of safety and well-being. By targeting the possible issues linked to the seven domains of complex trauma that underlie the presentation of traumatized individuals, survivors will feel more supported in their recovery and may be more likely to access appropriate support.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2018

Title: Prevention of RhD alloimmunization in Northern British Columbia
Contributors: Trina Marie Fyfe (author), University of Northern British Columbia School of Health Sciences (Degree granting institution), Geoffrey Payne (thesis advisor), Josée Lavoie (thesis advisor), Russ Callaghan (committee member), Suzanne Johnston (committee member), Davina Banner-Lukaris (committee member)
Abstract: Despite best practice guidelines, international evidence suggests that the provision of anti-D prophylaxis to RhD negative pregnant women is suboptimal. Missing from the literature is research exploring the factors that perpetuate suboptimal care and continue to put RhD negative pregnant women at risk for RhD alloimmunization. The purpose of this study was to understand why RhD negative pregnant women continue to be at risk for RhD alloimmunization in northern BC. The specific research questions were: How do healthcare providers make decisions regarding the care of RhD negative pregnancies in northern BC? How do RhD negative women in northern BC experience pregnancy? A qualitative approach utilizing interpretive description was used to address the need for the development of rural centric clinical guidelines. Interviews were conducted with RhD negative women about pregnancy and healthcare providers’ experiences in caring for RhD negative pregnancies in northern BC. A Stakeholder Committee guided the research process and provided insight into data analysis to ensure applicability to practice. A qualitative approach with these two populations has provided a greater understanding into the depth of quality of care for RhD negative pregnancies and the decisions that inform patient safety by revealing nuances of care that lead to potential miscommunication and near misses. Recommendations into guideline adaptation, decision-making and health literacy in rural healthcare settings are presented.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2018-02

Title: Rehospitalization risk factors for mental health and substance use in Northern British Columbia
Contributors: James Floyd Campbell (author), Shannon Wagner (thesis advisor), Glen Schmidt (thesis advisor), Caroline Sanders (committee member), Jalil Safaei Boroojeny (committee member), Mamdouh Shubair (committee member), Alasair Hodges (committee member), R. Luke Harris (chair), University of Northern British Columbia Health Sciences (Degree granting institution)
Abstract: Mental health and substance use (MH&SU) rehospitalization rates are used as indicators of treatment quality, to reduce costs, and measure efficacy. Research on this topic in rural Canadian hospitals and communities is lacking. This study used secondary data on 5159 patients (age 15 and older) hospitalized with International Classification of Disease (ICD) F code MH&SU diagnosis. These patients had 9103 admissions to 18 hospitals in Northern British Columbia during a five-year period, April 1st, 2010 through March 31st, 2015. ANOVA and Tukey Post Hoc tests were used to examine associations of two performance measures with five patient factors; community size, Indigenous culture, relationship status, employment status, and ICD F code diagnoses. The first measure was number of hospital readmissions. Of the 5159 patients with 9103 admissions, 3482 (67.6%) had one hospital admission during the five-year period. The remaining 1677 (32.4%) patients had 3944 (43.3%) of the hospitalizations). Patients whose cultural identity was Indigenous had over-representation and increased readmissions. Patients who were single and never in a relationship had increased hospitalizations. Patients whose ICD F coding for schizophrenia or psychosis had increased hospitalizations. The second measure was wait time for community MH&SU follow-up. Of the 5159 patients, 4512 (87.5%) had contact with community MH&SU during the five-years. Urban communities with specialized MH&SU services had reduced wait times for follow up. Patients whose cultural identity was Indigenous had longer wait times for community MH&SU follow-up. Patients who were divorced or separated had longer wait times. Patients with ICD F coding for schizophrenia or psychosis had shorter wait times for follow-up. The relationship between hospital readmission and community MH&SU follow-up was examined using logistic regression with the five factors. An inverse relationship was found between the two performance measures. Patients who did not have community MH&SU follow-up within 30 days had reduced odds ratio of readmissions, whereas patients who had follow-up within 30 days had increased odds ratio for readmissions. Although the study finds support for patient risk factors, evidence suggests approaches like a Decision Support Tool (DST) might provide reliability for intervention, and resource planning, as well as timely intervention.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2020

Title: Lean rapid process improvement workshops
Contributors: James Chan (author), Angela Seguin (thesis advisor), Jalil Safaei Boroojeny (thesis advisor), Balbinder Deo (committee member), Thomas Ritter (committee member), University of Northern British Columbia (Degree granting institution)
Abstract: Many studies purport that Lean is a useful approach to improving quality in healthcare, however, there are calls for better research designs to evaluate its effectiveness. This study used a mixed-methods approach to investigate Lean Rapid Process Improvement Workshops (RPIWs) applied to surgical services in a large health system. The main objective was to conduct an economic evaluation using the Return on Investment (ROI) method. Quantifying improvements at the event level to calculate ROI was not feasible, so the analysis defaulted to examining the cumulative effects of six separate RPIWs at two facilities. The results did not produce sufficient evidence to claim that the outcomes justify the investments. The study went beyond ROI by using various statistical analyses to examine the effects of RPIWs on key performance measures of surgical volumes, sick time, and overtime; with generally non-significant findings. To capture the intangible effects of Lean, key informant interviews explored the richness of participants’ experiences while a survey was used to gather data on experience and engagement from a larger number of participants. The RPIWs produced positive results when considered through a qualitative lens – respondents to the interviews and survey indicated that Lean RPIWs are a desirable method for improving healthcare. Thirteen in-depth interviews yielded six thematic enablers to engagement (a culture of improvement, dedicated time, gradual engagement, improvement interest, social aspects, and participants’ like for Lean). In addition, four themes that represent barriers to engagement were identified (apathy, finances, mis-fit, and resistance). Ten themes also emerged as recommendations for making Lean more engaging. This study contributes to the field by demonstrating the difficultly of empirically calculating the ROI of RPIWs, which leads us to challenge any unfounded claims of monetary benefit from improvement initiatives. It also stresses the importance of qualitatively understanding employees’ experience of Lean and the process of engagement, which is critical for any healthcare organization that wishes to improve its services, client care, and overall performance. The findings invite us to turn our attention away from discussions of financial ROI and toward other evidence that helps us understand how Lean can provide value in healthcare.
Discipline: Health Sciences
Content Model: info:fedora/ir:thesisCModel
Date added: 2018