Health (Faculty of)

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The Faculty was known as the Faculty of Applied Health Sciences prior to its name change in January 2021.

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Now showing 1 - 4 of 4

Antecedents and Consequences Associated with Health Literacy or Health Numeracy in Adult Immigrants and Refugees: A Systematic Review of Empirical Evidence
(University of Waterloo, 2018-09-19) Zhu, Meng; Arocha, Jose
Background: Health literacy and health numeracy refer to skills that are fundamental and essential to fulfill health activities. Limited health literacy and numeracy levels have been associated with various poor health outcomes, such as increased emergency department or hospital visits, difficulty in interpreting health messages, inability to take medications properly, and increased mortality in older people. Immigrants and refugees tend to have inadequate health literacy skills, compared to the native-born population, indicating that they may be more susceptible to suffer the negative impacts of low health literacy. Currently, many empirical studies have investigated the antecedents (factors which could influence or predict health literacy or health numeracy, such as demographics) and consequences (outcomes that result from different health literacy or numeracy levels, such as mortality) of health literacy or health numeracy in adult immigrants and refugees. However, efforts that summarize the relevant empirical evidence do not exist. Objectives: The thesis research aimed to bring together individual empirical studies dispersed in the literature and synthesize both quantitative and qualitative evidence in regards to antecedents and consequences of health literacy or health numeracy in adult immigrants and refugees by applying the systematic review approach. My purpose was not to quantitatively synthesize the results on a specific antecedent or consequence in a specific immigrant or refugee population, but to narratively summarize the relevant evidence to provide information on what antecedents and consequences of health literacy or health numeracy have been investigated in the adult immigrants and refugees, to identify potential research gaps, and to offer insights for future research and practice. Methods: The reporting of the systematic review mainly followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) checklist. Index terms and free terms relating to health literacy, health numeracy, immigrants and refugees were searched in eight databases, including PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, SCOPUS, the ProQuest Dissertations & Theses database, the Conference Proceedings Citation Index-Science (CPCI-S), and the Conference Proceedings Citation Index-Social Science & Humanities (CPCI-SSH). Studies that met the eligibility criteria were included. The reviewers assessed the risk of bias of each individual study and narratively synthesized the extracted evidence by thematic identification. The thematic identification mainly followed the framework approach, in which a working thematic framework was established. The working thematic framework consisted of themes and subthemes pre-existing in Sorensen’s comprehensive conceptual model for health literacy and numeracy. Antecedents and consequences from the included studies were coded with these themes and charted into a matrix, the row of which represented an included study, and the column of which denoted to the themes. Additionally, we also carried out inductive thematic identification for the antecedents and consequences that did not fit the pre-existing themes. Results: In total, 77 included studies, published between 2004 and 2018, were included. Forty-nine of them were quantitative research, out of which 47 applied the cross-sectional study design and two adopted the cohort study design. The rest 28 included studies were qualitative, all of which conducted thematic analysis with information collected by interviews or focus groups. Sixty-seven studies focused on only health literacy; 1 on health numeracy only; and 9 involved both. In terms of the research sample, 63 included studies involved immigrants, 13 investigated refugees, and one involved both. Twenty-four and 58 included studies explored antecedents and consequences, respectively. The antecedents were coded with the following themes (subthemes): personal antecedents (personal characteristics and personal competence), societal and environmental antecedents, and personal belief, experience, and behaviour. The consequences were coded with themes including health service use or behaviour, health outcome, health cost, health experience and perception, and health knowledge and understanding. Conclusion: The systematic review was the first study to examine the current state of the research activities on antecedents and consequences of health literacy or health numeracy in the population of adult immigrants and refugees. Our major findings suggest the following recommendations: 1) Future research needs to direct more focus on other health literacy dimensions, such as interactive critical health literacy, rather than the functional dimension of health literacy (i.e., reading and writing skills) in adult immigrants and refugees. 2) More empirical research is needed on antecedents and consequences of health numeracy in adult immigrants and refugees. 3) Inductively identified themes such as “personal belief, experience, and behavior” for antecedents and “personal experience and perception” and “knowledge and understanding” for consequences should be added for the further development of the current framework for health literacy and health numeracy in the context of immigrant and refugee health. 4) More research is required on the associations between health cost and health literacy or numeracy in adult immigrants and refugees. 5) Future quantitative studies need to apply more advanced study designs (e.g., cohort studies) and improve the sampling methods to increase their research validity. 6) Immigrant- and refugee-specific antecedents (e.g., primary language, acculturation, duration of residence in the destination country) and consequences (e.g., health needs) should draw more attention in future empirical research.
In Danger? An Exploration of Canadian Truck Drivers’ Health through the Canadian Community Health Survey
(University of Waterloo, 2016-01-04) Wawzonek, Peter Aaron; Bigelow, Philip; Arocha, Jose
Background: There exists substantive evidence showing that the health status of truck drivers from the United States (US) is much poorer than the general US population. Comparatively there is much less research on Canadian truck drivers, however the macroergonomics of the motor carrier industry in both countries makes it challenging for drivers to maintain a healthy lifestyle. Thus Canadian truck drivers may also be at risk for poor health outcomes. The objectives of this thesis are threefold; to: (1) estimate the prevalence of chronic diseases in Canadian truck drivers and determine if the prevalence rates are higher than in the Canadian population, (2) identify and quantify the risk factors for chronic diseases in Canadian truck drivers, and (3) elucidate the variables that significantly correlate to BMI in Canadian truck drivers. Methods: A sample of 991 male truck drivers was compared to 29,958 male respondents of a similar demographic profile in the Canadian Community Health Survey (CCHS) from 2009-2010 (Cycle 5.1). The samples were comprised of those who were aged 18-65, worked 10-130 hours a week, had an income of at least $20,000, and had a Body Mass Index less than 60. The sample was restricted to males since female truck drivers make up less than 5% of the truck driver population, and there would be an insufficient sample size of female truck drivers to generate statistically sound confidence intervals. Furthermore female truck drivers have similar morbidities when compared to males. Cycle 5.1 of the 2009-2010 CCHS was used as this was the last year that occupation was measured in the CCHS. The reporting of occupation made this analysis on truck drivers possible. The CCHS is a cross sectional design survey which had a multi-stage stratified clustering sample design which obtained samples from all health regions of Canada. Chi-squared and regression analyses were performed, following bootstrapping and application of sample weights. Results: When compared to other working males in the CCHS, male truck drivers had an adjusted Prevalence Ratio (PR) of 1.45 (p<0.05) for heart disease, thus male truck drivers were 1.45 times as likely to report having heart disease as compared to other male workers. Prevalence ratios reported were adjusted for age, hours worked per week, household income, marital status, and education, as these were significantly different between populations in the Chi Square analysis. Truck drivers also had other adjusted PRs with p<0.05; higher BMI (PR of 1.69 for being obese, and 1.45 for being overweight, versus having a BMI in the normal range) higher amphetamine usage (PR of 2.04 for reporting usage “More than once” versus no usage), lower seat belt usage (PR of 5.99 for reporting using a seatbelt “Rarely” or “Never” versus “Always” or “Most of the Time”), higher rates of smoking (PR of 1.49 for being a daily smoker versus never smoking), high rates of fatigue (PR of 2.74 for the reported frequency of driving while tired being “Often” versus “Never”), lower levels of physical activity (PR of 0.52 for being active [versus inactive]) and lower fruit/vegetable intake (PR of 0.76 for reporting consuming 5-10 fruits/vegetables per day vs less than 5 fruits/vegetables per day). Although these prevalence ratios were expected based upon the literature review, some findings were unexpected: truck drivers lower prevalence ratios for frequency of having 5 or more drinks, prevalence of mood disorders, and self-perceived work stress and self-perceived life stress. Linear regression analysis on BMI was performed, elucidating that smoking status and daily physical activity over 15 minutes long significantly explained the variation in BMI; the more one smoked and the more active one was, the lower their predicted BMI was. Conclusion: This sample of truck drivers was markedly different from other employed Canadian workers with respect to chronic disease prevalence and overweight status. Findings, such as the relationship between smoking, physical activity and BMI, will be useful in designing intervention studies to improve the health of truck drivers.
Patients’ Accounts of Non-Acceptance and Non-Adherence to Drug Treatment in Depression A Scoping Review and Narrative Synthesis of Research Findings on Patients’ Views on Antidepressants
(University of Waterloo, 2017-06-19) Pasterkiewicz, Urszula Barbara; Mielke, John; Arocha, Jose
Major depressive disorder (MDD) is a disabling condition with a high frequency of recurrence and non-recovery, resulting in serious morbidity and mortality (Kessler & Bromet, 2013; Stotland, 2012; Alonso et al., 2013). Depressive patients are said to report persistent symptoms and long-term disability despite high primary care utilization and medicines, and this notion is challenging the efficacy of existing models of care (Stirling et al., 2001; Ambresin et al., 2015). Despite increased numbers of issued prescriptions, the prevalence of depression remains static (Ambresin et al. 2015; Baxter et al., 2014; Wittchen et al., 2011), or demonstrates progressive course (Mojtabai et al. 2016; Hidaka, 2012). This striking polarity of findings opens space for further research. Former studies designed to promote medications for the treatment of depression generated rather discouraging findings (Aikens et al., 2008; Kutcher et al. 2002; Brook et al. 2005; Pampallona et al., 2004; Katon et al., 2001). It seems imperative to undertake a careful analysis of reasons, for which the low effectiveness of treatment may result from its low utilization. A better understanding of individual views on antidepressants may help improve adherence as well as patient-centeredness in depression care and suggest innovative, more effective intervention strategies. Purpose of the study: This review summarises patients’ accounts of experiences with drug therapy in depressive disorder. Perceptions of mood-stabilizing drugs have been explored with the aim to unravel negative treatment decisions. Individual and common beliefs that lead to refusal of antidepresant treatment as well as challenges experienced during initially accepted and initiated treatment have been identified and explained. Methods: With the help of Arksey and O’Malley’s scoping review methodology as a guide, several databases were searched: MEDLINE through PubMed, Scopus, PsycNET and Google Scholar. In addition, bibliographies and references of relevant studies were searched online. As a result, 41 qualitative research papers remained the core of this work. Design triangulation was used to examine the consistency and reliability of qualitative data with 71 quantitative and mixed-methods studies. Concepts emerging from summarized findings are presented in a thematic analysis. The research was conducted in a manner that will allow this review to be replicable. Findings: Utilization of antidepressants continues to raise concerns. Existing scholarly evidence concerning attitudes and people’s behavior in relation to mood-stabilizing drugs uncovered a rich spectrum of ethical, racial, cultural and emotional underpinnings of medical treatment. There were accounts of patients who both accepted and refused drug treatment in the process of acceptance or denial of their depressive condition. Pattern of ignorant or dismissive behaviors observed in health care professionals was the cause of major frustration. Conclusions: depressive patients either fully refuse the medicines or they do not adhere to recommended treatment. The analysed studies provide evidence that adherence to antidepressants is a complex health behavior that is mediated by multiple factors based on patients’ cultural, religious and ethical beliefs. The most serious reasons for non-compliance are adverse side effects and frustration experienced due to lack of efficacy of drug treatment and absence of permanent cure after prolonged use of medications. A major concern is the quick diagnostic procedure based on patient’s self-report and the ease of prescribing antidepressants viewed by patients as unnecessary and harmful. Complains about lack of continuous medical support indicate an urgent need of revision of existing mental-health services and regulations.
Readability and Coherence of Canadian Provincial Department/Ministry of Health HPV Information Intended for the Lay Population
(University of Waterloo, 2016-01-22) Tulsieram, Kurt; Lee, Joon; Arocha, Jose
Background: Human Papilloma Virus (HPV) is a prime factor in the development of many cancers and genital warts in Canada. A majority of sexually active Canadians are likely to have a HPV infection during their lifetime. Information provided online by each specific provincial department/ministry of health in regards to HPV and vaccination may not be at an ideal standard for the lay population to understand and should be evaluated. Purpose: To assess the readability and coherence of provincial department/ministry of health HPV information to determine if it is adequate for the Canadian lay population to understand. Methods and Results: Seven of 10 Canadian provincial department/ministry of health’s HPV information websites were evaluated for readability and coherence. The readability tools Gunning-fog index and SMOG (Simple Measure of Gobbledygook) both found that approximately 60% of the population for each of the provinces evaluated may be able to understand the information. The coherence measures of latent semantic analysis (LSA) and computerized propositional idea density rater (CPIDR) both concluded that relative to the benchmark that represents the lay population, the coherence level is not appropriate (LSA, p< 0.001and CPIDR, p< 0.001). Interpretation: HPV information provided by the Canadian Provincial department/ministry of health websites may not be adequate for the lay population to understand. Readability and coherence are important factors that should be considered to improve the quality and adequacy of the information provided so the message reaches the Canadian population.

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