The MAP Survey Research Unit has experience on a variety of research methods on topics related to social determinants of health, health equity and access to care.
HIV pre-exposure chemoprophylaxis (PrEP) is recommended for populations at high ongoing risk for infection. There are noted racial disparities in the incidence of HIV and other sexually transmitted infections (STIs) for African, Caribbean, and Canadian Black (Black) populations in Ontario. Although Blacks represent only 4.7% of the Ontario population, they account for 30% of HIV prevalence and 25% of new infections in the province. HIV pre-exposure chemoprophylaxis (PrEP) is recommended for populations at high ongoing risk for infection.1 Significant scientific gaps remain regarding the best strategies for supporting PrEP scale up among Blacks. Research evidence on self-determination theory (SDT) indicates that informed and autonomous decision-making is a central component to facilitating motivation for long term maintenance of health behaviours, such as daily oral PrEP.
To date there is no known formalized intervention in place designed to support ACB men and women at high-risk to make high quality decisions regarding the adoption of PrEP as an HIV prevention practice. This study proposes two aims to address these gaps in HIV prevention and implementation science.
Client/Principal Investigator: Dr. LaRon E. Nelson
SRU Role: Project management, data collection, qualitative data analysis.
This research aims to evaluate the effect of financial incentives in facilitating engagement with a brief case management intervention for people experiencing homelessness and mental illness after discharge from hospital. The study will examine the health, health service use, and housing outcomes for those receiving financial incentives compared to those receiving usual services over a 6 month period after hospital discharge. We are using a randomized controlled design and mixed methods to conduct a pragmatic field trial. Study participants are being recruited among new CATCH clients at the time of referral to CATCH and are randomized into receiving either the financial incentives intervention (CATCH-FI, N=86) or usual CATCH care (CATCH-UC, N = 86).
Client/Principal investigators: Vicky Stergiopoulos.
SRU role: Project management, instrument and protocol revision, data collection.
Readmission to hospital has been a prominent area of focus for health care researchers and policymakers given its high prevalence and financial burden on the health care system. Despite the growing attention paid to hospital readmissions in the general population, very few studies have focused on risk factors for re-hospitalization among people experiencing homeless. The purpose of this study is to examine factors that may cause readmission to hospital among people experiencing homelessness within 90 days of discharge from a general medical unit at St. Michael’s Hospital. It is well known that people experiencing homelessness have higher rates of health care use and suffer more from disease than the general population. This study will aim to identify the causes of hospital readmissions among people experiencing homelessness and provide the foundation for future studies to prevent recurrent hospitalizations, reduce health care costs, and improve health outcomes.
Client/Principal Investigator: Dr. Stephen Hwang
SRU Role: Project management, data collection.
The goal of Our Health Counts is to improve Ontario’s urban Aboriginal health data, through the identification of the health indicators that are relevant to Canada’s urban Aboriginal People; and the development and application of a baseline population health database for urban Aboriginal People in Ontario. This data is needed to inform effective and culturally appropriate population health programs and policies to improve the health of Aboriginal individuals, families, communities, and nations.
Client/Principal investigator: Dr. Janet Smylie.
SRU role: Survey instrument programming and data hosting for OHC Toronto, London, Kenora and Thunder Bay.
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Using a quasi-experimental approach, this realist informed evaluation applies multiple, longitudinal quantitative measures to examine and compare the physical health, mental health, subjective, and role functioning recovery outcomes of intervention participants, from the STAR Learning Centre, compared to participants in a comparison arm, as well as qualitative methods to unpack the intervention’s key ingredients and theory of change.
Client/Principal investigators: Vicky Stergiopoulos.
SRU role: Project management, instrument and protocol revision, data collection. Participants are followed for 1 year and interviewed every 6 months. Interviews are conducted in-person using a computer-assisted program.
This experimental, longitudinal study compared and followed applicants on the waitlist for rent-geared-to-income (RGI) units , with those who have received RGI. The sample size was 500+ people at four different regions in the GTA, who were followed every six months.
Client/Principal Investigator: Dr. James Dunn.
SRU role: Project management and data collection.
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This experimental study follows Toronto Community Housing residents living in south east Toronto to determine if: (1) adults re-housed from aging public housing into a new mixed housing development are significantly more likely to show changes in mental health and general health status; and (2) Children re-housed from aging public housing into a new mixed housing development are significantly more likely to show changes in mental health, behavioral and developmental competencies.
Client/Principal Investigator: Dr. James Dunn.
SRU role: Project management and data collection.
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The OBIP was introduced by the province of Ontario with the objective of studying the impact of a guaranteed Basic Income on food security, stress and anxiety, mental health, health and healthcare usage, housing stability, education and training as well as employment and labour market participation.
The pilot operated in three communities in Ontario. With a mixed design, two sites operate as a randomized control trial (Hamilton/Branford and Thunder Bay) and a third site operates as a saturation site (Lindsay).
As a member of the OBIP Evaluation Team, the Survey Research Unit was responsible for survey data collection for the pilot (target: 6,000 participants).
The pilot was interrupted before it ended due to a decision of the new elected government.
The Evaluation Team Co-Leads were Drs. Stephen Hwang and James Dunn. For more information about the pilot click here.
Culture is widely recognized and accepted as a significant driver in changing behavior and expectations in order to increase safety within organizations. A key step in this process is the ability to measure the presence and degree of safety culture. An objective of the network’s 2018-19 Quality Improvement Plan is to gain a comprehensive understanding of safety culture and practices and to specifically perform a current state assessment of safety culture as a foundation to build a quality and safety strategy. Using the Agency for Healthcare Research & Quality’s (AHRQ) Safety Culture Survey will allow the network to gain valuable insight into staff and provider perceptions of patient safety, as well as indications of areas of strength and improvement and provide metrics in order to monitor changes.
Client/Principal Investigator: SMH Quality Improvement Department
SRU Role: Project management, data collection, data analysis and reporting.
The Toronto Central LHIN’s new strategic priority, Transforming Primary Health and Community Care, aims to improve patient access to care, service integration, and system efficiency. This is a complex healthcare innovation as it is the first time in the history of healthcare in Ontario where the LHINs have a written mandate to work with all physicians. The SRU will be implementing a Developmental Evaluation approach to support this initiative. Developmental Learning will be used to gather data on how to best move forward with selected priorities, such that they align with the vision and principles of the Toronto Central LHIN. Developmental Learning looks at ‘how’ and ‘why’ an initiative is or is not working to help understand what mechanisms make the initiatives successful. Priorities include Access, Attachment, and Continuity; Access to Inter-professional Teams; Access to Specialists; Discharge Planning; Secure Communications; and Engagement.
Client/Principal Investigator: Dr. Patricia O’Campo
SRU Role: Project management and coordination, data collection, as well as overall evaluation support.
Literature review encompassing (1) Description of known palliative care models for the homeless population. (2) Description of identified challenges for the provision of palliative care for the homeless population. (3) Description of the Homeless population in Toronto. (4) Description of the current state of the palliative care services in Toronto, with specific attention to individuals experiencing homelessness. Key informant interviews with representatives of Homeless/palliative care services organizations in Toronto.
Client: TC LHIN
SRU Role: Project management, literature review, data collection and report writing.
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Systematic review of the methodologies used to evaluate Basic Income programs around the world.
Client/Principal investigators: Andrew Pinto
SRU Role: Project Management, systematic review.
A randomized controlled trial where participants were randomly assigned into a housing intervention treatment group or a treatment as usual group. Both groups were interviewed at baseline and at fixed intervals after the intervention. The “Housing First” approach provides safe, quality housing to people who are homeless and live with mental health issues, to help clients better focus on recovery. The study will generate evidence about participant outcomes. It will also identify the overall costs of “Housing First” and treatment as usual, taking into account how much the two study groups use costly services like hospitals, prisons and shelters.
Client/Principal investigators: Drs. Stephen Hwang, Vicky Stergiopoulos and Patricia O’Campo.
SRU role: Project management, instrument and protocol revision, data collection. Randomized participants are followed every 6 months. Interviews are conducted in-person using a computer-assisted program.
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This study evaluated the Health Equity Survey (HES) initiative implemented within the family practice at St. Michael’s Hospital. The qualitative component of the study focused on the qualitative understanding of the HES data collection experience, implementation and administration, including potential uses and harms of data collection.
Overall study type: Concurrent mixed-methods evaluation
Client/principal investigators: Drs. Andrew Pinto and Tara Kiran
SRU role: Project management of qualitative component, data collection and coding
This project surveyed primary care physicians within the boundaries of the Toronto Central Local Health Integration Network (TC LHIN) to understand the behaviours, barriers and facilitators of referring patients to community services.
Study type: Cross sectional study
Client/principal investigators: Dr. Patricia O’Campo
SRU role: Project management, instrument development and data collection
Four case studies (Norway, Scotland, Ecuador and Thailand) of HiAP implementation were completed. Qualitative interviews were conducted to elicit rich data on what strategies drive sustainable implementation in a diverse sample of jurisdictions. Key informants were initially identified through literature and document review, while snowball sampling was done to find additional key informants who participated in implementation. Interview questions and related probing, were centred on main and rival propositions. When applicable, interviews were conducted with an interpreter.
Overall study type: Qualitative interviewing
Client/principal investigator(s): Dr. Ketan Shankardass
SRU role: Project management, instrument development assistance, data collection and transcription
In 2012, the Toronto Central Local Health Integration Network (TC LHIN) created the Language Services Toronto (LST) program to provide an initial group of community and health care organizations with greater access to professional over-the-phone interpreters so all patients could access care regardless of the language they spoke. Following the first year of LST implementation, the TC LHIN identified the need to evaluate the program before expanding to more organizations within and outside the TC LHIN. This evaluation measured perceived satisfaction, appropriateness, usage and impact of the program, from the perspectives of both providers and patients.
Study type: Sequential exploratory mixed-methods evaluation
Client/Principal investigator: Dr. Patricia O’Campo
SRU Role: Study design, project management, protocol development, data collection, data analysis and report writing
For more information consult the Evaluation Report and related Article.
https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-015-0212-9
St. Michael’s 3.0 is a project to renew St. Michael’s Hospital; it includes renovations to the emergency department and a 17-storey state-of the art patient care tower. The Hospital Facilities Survey and the Hospital Retail Services Survey were the first surveys launched by the St. Michael’s 3.0 Patient and Family Advisory Panel. The panel was created to get feedback from St. Michael’s patients and their family members and friends to ensure that the development of St. Michael’s 3.0 meets their needs.
Client/Principal Investigator: St. Michael’s Communications Department.
SRU role: Instrument development and data collection.
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This is a mixed methods study that includes: Delphi Technique (web-based), Systematic Screening Processes (telephone, fax, web, mail and email), and National surveys with service providers and institutions. Main objectives: (1) To develop consensus definitions of transition points across the care continuum to inform seamless integrated care. (2) To develop a national inventory of institutions and service providers managing patients at risk of and requiring prolonged mechanical ventilation (PMV) or long-term mechanical ventilation (LTMV). (3) To describe current clinical care practices, available information and education resources for patients: (a) at-risk of LTMV in the community; (b) requiring PMV/LTMV in an institution; (c) requiring PMV/LTMV in the community; and (d) transitioning from pediatric to adult care requirements.
Client/Principal investigator: Dr. Louise Rose.
SRU role: Project management and data collection.
The main focus of this study was to describe the experiences of housing instability among men with gambling experiences. Peer interviewers conducted semi-structured with men who have experiences with gambling and housing instability (as identified through the Problem Gambling Prevalence Study). The interviews focused on understanding the different pathways to housing instability, current barriers to treatment for gambling, and opportunities to intervene along the pathway to housing instability or problem/pathological gambling.
Overall study type: Peer interviewers, qualitative interviewing
Client/principal investigator(s): Dr. Flora Matheson
SRU role: Project management, instrument and protocol revisions and data collection
LINK TO ARTICLE http://journals.sagepub.com/doi/pdf/10.1177/1468794115626244
The purpose of the Problem Gambling Prevalence study was to estimate the prevalence of problem gambling among clients of the Good Shepherd Centre. Using a time-location approach, clients were screened on-site at the organization using the NORC DSM-IV Screen for Gambling Problems questionnaire. Clients were screened based on their lifetime gambling experiences.
Overall study type: Quantitative, Time-location sampling
Client/principal investigator(s): Dr. Flora Matheson
SRU role: Project management, methodological design and data collection
LINK TO REPORT https://research.unityhealth.to/wp-content/uploads/2016/12/gamblingreportmay8.pdf
LINK TO ARTICLE ABSTRACT https://www.ncbi.nlm.nih.gov/pubmed/24569904
This study investigated the experiences of social mix among public housing tenants, purchasers of market condominiums and non-resident users of new commercial and public services within Toronto’s Regent Park area to understand how the development of new private and public community resources influence interaction between residents of differing socio-economic status and affect the experiences and perceptions of social exclusion/inclusion among low-income residents as well as attitudes of (in)tolerance among more affluent purchasers of market condominiums.
Study type: Cross sectional study
Client/Principal Investigator: Dr. James Dunn.
SRU role: Project management, instrument and protocol revisions and data collection.
Urban HEART stands for Urban Health Equity Assessment and Response Tool. In 2010, the World Health Organization launched Urban HEART to help city leaders and their communities resolve health and social inequities. Urban HEART @ Toronto used an e-Delphi methodology where expert panels were formed to build consensus around Urban HEART indicators relevant for Toronto. Key experts were recruited and completed a series of surveys around the following five domains: Physical Environment and Infrastructure, Population Health, Social and Human Development, Economic Opportunity, and Governance.
Overall study type: e-Delphi
Client/principal investigator(s): Kelly Murphy
SRU role: Project management, instrument development, expert panel recruitment, data collection and analysis
The Health in All Policies concept is an initiative organized at the government level that understands that improving health overall requires actions from governments from both health and non-health sectors at various levels. This pilot project involved conducting case studies of three different areas (Sweden, South Australia, and Quebec) to understand their experiences with HiAP initiatives.
Client/Principal investigators: Dr. Patricia O’Campo.
SRU role: Project management and data collection. A total of X interviews were conducted.
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The purpose of this project was to develop an understanding of the relationship between neighbourhoods, health, and well-being. The project used data from multiple sources including face-to-face interviews as well as Census data, observational neighbourhood data, and provincial health information. A total of 2400 participants from 48 neighbourhoods across the city of Toronto were recruited over-the-phone and interview in-person using a computer-assisted survey instrument.
Client/Principal investigators: Drs. Patricia O’Campo and Blair Wheaton.
SRU role: Project Management and data collection.
The purpose of this research was to learn about the role of housing in the health and social well-being of women by conducting qualitative interviews with women who have experienced recent relationship conflict and have lived in social, transitional or independent dwellings.
Client/Principal investigators: Dr. Patricia O’Campo.
SRU role: Project management, instrument development and data collection.
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