Theses (Social Dimensions of Health)
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Item Manidookewin: Exploring community wellness with Elders and knowledge keepers in Whitesand First Nation(2025) Willoughby, Kyra; Wright Cardinal, Sarah; Allan, BillieThis research explores community health and wellness guided by the wisdom of three Elders and knowledge keepers from Whitesand First Nation and is rooted in Anishinaabe ways of knowing and being. Using Indigenous research methodologies and guided interviews informed by Jo-Ann Archibald’s (2008) Indigenous Storywork framework, this study examines the research question, “How do Elders and knowledge keepers in Whitesand First Nation define community wellness?”. Through an Indigenized thematic analysis, the conversations with these Elders and knowledge keepers revealed four main themes along with subthemes that provide insights into our community wellness practices as Anishinaabe people from Whitesand First Nation. These bundles of knowledge were organized in a visual representation of a medicine wheel and were placed in the corresponding sectors that represent the life cycle for us as Anishinaabe people. The first theme was Culture and it was placed in the East, Waabinong, which included the subthemes of Language, Cultural Resiliency and Resurgence, and Sense of Belonging. The second theme, Land, was placed in the South, Zhaawanang, and contains the subthemes of Medicine and Healing, and Source of Life. The third theme, placed in the West, Ningaabii-anong, was Community, animated by the subthemes of Intergenerational Learning, Taking Care of one Another, and Roles and Responsibilities. The last theme that revealed itself was Spirituality and this was placed in the North, Kiiwedinong. The subthemes within this section include Ceremony, Prayer, and Interconnection. This study provides understandings of Anishinaabe community wellness and offers insights to the roots of Anishinaabe wisdom and knowledge.Item 2SLGBTQ recreational sport participation: Mental health, social support and community connection(2025) Wells, Gordon A.; Lachowsky, Nathan; Souleymanov, RustyCommunity sport participation is increasingly promoted as a strategy to support people’s health and wellbeing. Without strategies that account for the harassment and marginalization that many Two-Spirit, lesbian, gay, bisexual, transgender and queer (2SLGBTQ) people experience in sport, the promotion of community sport may further compound health disparities experienced by 2SLGBTQ people. Despite these experiences of harassment and marginalization, 2SLGBTQ people have created their own 2SLGBTQ recreational community sports teams and leagues to exercise, socialize and play with other 2SLGBTQ people. In this dissertation I conducted a series of analyses to understand the relationship between 2SLGBTQ recreational sports participation and the mental health and sense of community connection of 2SLGBTQ people in Canada. My first analysis is of data from the Momentum study, a longitudinal prospective cohort study on the health of gay and bisexual men (GBM) in Metro Vancouver, comparing self-reported questionnaire findings on those who participated in 2SLGBTQ recreational sports with those who did not. I also compared outcomes between those who saw a change in their 2SLGBTQ sports participation (e.g. started or stopped 2SLGBTQ sport participation). I found no significant differences in mental health measures, but GBM who participated in 2SLGBTQ sports reported more social support and were less likely to report being in poorer health. GBM who started participating in 2SLGBTQ sports reported higher community participation and were less likely to report being in worse health. Lastly, GBM who stopped participating were less likely to have depression scores in the normal range. The second analysis sought to understand if transgender, nonbinary and gender diverse (trans) people’s participation in 2SLGBTQ recreational sports is associated with improved mental health, social support and sense of connection with 2SLGBTQ communities. My analysis is conducted on data drawn from the 2019 and 2022 cycles of the community-based, cross-sectional Sex Now study. Compared with those who did not participate in 2SLGBTQ recreational sports, trans people did not report a significant difference in anxiety symptoms, but did report lower depressive symptoms and higher satisfaction with their relationship to the 2SLGBTQ community. My final analysis is of data from the Our Health study, a cross-sectional, community health survey on 2SLGBTQ people across Canada. I sought to understand the relationship between 2SLGBTQ recreational sport participation and 2SLGBTQ people’s mental health, social support and sense of 2SLGBTQ community connection. I also sought to understand if age moderated any of these potential associations. I found that while participants of 2SLGBTQ recreational sports reported similar levels of anxiety and depression symptoms as non-participants, they demonstrated significantly higher social support and 2SLGBTQ community connection. These associations held for younger and older 2SLGBTQ people. My research has found a strong relationship between 2SLGBTQ people’s participation in 2SLGBTQ sport and improved mental health, social support and sense of connection to 2SLGBTQ communities. This dissertation provides insights for social service and healthcare policy and practice to engage 2SLGBTQ recreational sport to support the health and wellbeing of 2SLGBTQ people across Canada.Item Transforming supports: Trauma-related mental health care with trans and gender-diverse young people(2025) Walker, Mattie; Lachowsky, Nathan; Devor, Aaron H.Previous research in Canada and internationally has consistently found that trans and gender-diverse (TGD) people face barriers to accessing the mental health care that they need. This dissertation presents findings from the qualitative, community-based project Transforming Support, which engaged with 34 TGD young people to understand TGD young people’s experiences with trauma-related mental health care and identify recommendations and priorities for improving this care for these communities. Utilizing two qualitative methods for data collection, in-person community consultation workshops with 15 participants, and online, semi-structured interviews with 19 participants, this project focused on TGD young people’s experiences with: navigating barriers to accessing mental health care; experiences of safety with mental health care providers; and community goals and priorities for future research on improving mental health care for TGD communities. This dissertation is presented as three articles formatted for publication in peer-reviewed journals for academic and practitioner audiences. The first paper presents findings related to navigating barriers to care. Participants shared their experiences with seeking and accessing trauma-related mental health supports and spoke to the barriers they experienced in their navigation of mental health care services in their communities. This work provides insight into the ways that TGD young people are navigating barriers to care which can inform recommendations for improving access to trauma-related mental health care for these communities. The second paper provides insight into how TGD people are experiencing and navigating safety within these contexts and points to future areas of inquiry regarding enhancing available training and building towards TGD-competency or -literacy training that encourages self-reflexive practice. The third paper focuses on research priorities articulated by TGD young people. Findings suggest that future researchers be strategic in building projects that shift the focus from research on TGD people to research that focuses on mental health practitioners, practice approaches, and frameworks that acknowledge the multifaceted lived experiences of TGD people. This article calls for future research to pushback against deficit-focused narratives and an over-focus on harm experienced by TGD people.Item Substance use among transgender and non-binary people in Canada(2024) Gioi, Tran Minh; Lachowsky, Nathan; Urbanoski, KarenBackground Substance use is a public health concern. There is a paucity of population research comparing substance use between transgender and non-binary (TGNB) people and the general population and examining substance use correlates among TGNB sex/gender groups. My dissertation aims to 1) estimate and compare substance use prevalence among TGNB people and the general population in Canada; 2) examine correlates of hazardous alcohol drinking among TGNB people in Canada; and 3) examine how cigarette and e-cigarette use changed between pre-COVID-19 and after the first six months of the COVID-19 pandemic and examine the effects of COVID-19 impacts on changes in cigarette and e-cigarette use among TGNB people in Canada. Methods To meet the first aim (manuscript 1), I estimated and compared substance use prevalence (using standardized prevalence differences) among 2,294 TGNB people (from Trans PULSE Canada survey - TPC) and the general population in Canada from two national population-based surveys, the 2017 Canadian Tobacco, Alcohol, and Drugs Survey (CTADS) and the 2017-2018 Canadian Community Health Survey (CCHS). For my second aim (manuscript 2), I employed minority stress theory to examine potential predictors of hazardous alcohol drinking (HAD) among 2,324 TGNB individuals from the TPC. Logistic regression models were fit to examine the effects of 1) minority stressors and discrimination and 2) stress-buffering factors on the likelihood of HAD, stratified by gender. For my third aim (manuscript 3), within-person changes in cigarette and e-cigarette use between the two time points among 767 TGNB individuals who participated in the TPC (baseline) and the Trans PULSE Canada Cohort COVID survey (follow-up) were calculated. Multinomial logistic regression models were fit to examine mental health, social support, and pandemic-related predictors of changes (compared with no change) in cigarette and e-cigarette use. Results I found that TGNB people used fewer cigarettes and alcohol, but more e-cigarettes, cannabis, and unregulated drugs than the general population in Canada. Enacted discrimination predicted higher odds of HAD in all four TGNB sex/gender groups. Social support was associated with lower odds of HAD in trans men, non-binary assigned female at birth (NB-AFAB), and non-binary assigned male at birth (NB-AMAB) groups, but with higher odds of HAD in trans women. Mixed effects of gender distress, gender positivity, and gender-affirming medical care were also reported across sex/gender groups. More participants reduced (6.1%) than increased (3.3%) their cigarette use. Approximately equal numbers of participants increased (4.8%) and decreased (4.1%) their e-cigarette use. Increased e-cigarette use (compared with no change) was associated with working more during COVID-19 and a negative impact of COVID-19 on one’s financial security. Greater depression at baseline was associated with higher odds of reduced cigarette use. Higher social support was associated with lower odds of increased cigarette use. Conclusions My dissertation provides an understanding of different aspects of substance use among TGNB people in Canada, including robust population-level evidence on substance use disparities between TGNB groups and general population, understanding about predictors of past-year HAD within and across the TGNB population, and change in cigarette/e-cigarette use and predictors of such change following onset of the COVID-19 pandemic. Substance use patterns also differed by TGNB sex/gender groups, calling for tailored public health strategies to substance by TGNB groups. My dissertation findings also suggest that harms of substance use could be mitigated through public health policy and interventions that consider reducing structural discrimination, strengthening social support, ensuring financial security, and addressing mental health problems, tailored for distinct TGNB sex/gender groups.Item Gendered dimensions of food systems in Nunavik, Quebec(2024) Beale, Dorothy; Little, Matthew; Corntassel, JeffFood insecurity is a health equity issue that disproportionately impacts Inuit across Inuit Nunangat (the Inuit homelands) compared to the general Canadian population. Reduced access to traditional (country) food sources through hunting and fishing has paralleled increased consumption of market foods, including non-nutrient-dense foods. This dietary transition has led to a rising prevalence of non-communicable diseases such as diabetes, heart disease and obesity. Inuit women specifically face disproportionately higher rates of food insecurity compared to Inuit men, which is attributed in part to colonially enforced gender roles, high levels of environmental contaminants (e.g., lead, mercury, and persistent organic pollutants) in country food sources, and social and cultural factors of prioritization of family needs at the expense of personal food security. Women play important roles in food systems; they are knowledge holders, provision both country and market food, and participate in hunting and fishing. However, due to the lack of disaggregated and qualitative data in Western academic resources, there is a gap in understanding the gendered impacts of food insecurity, country food consumption, and gender roles within food systems in Inuit Nunangat. Using a community engaged, Indigenist approach, this study documents the experiences of Nunavimmiut women to explore the role and impacts of gender in food systems in Kangirsuk, Québec. We used convenience and snowball sampling to recruit a diverse group participants, then conducted semi-structured interviews with all participants. We spoke with fourteen participants, including both women and men. Results show that gender roles have shaped and continue to shape women’s experiences within food systems in Kangirsuk, QC. This is evident through various aspects, primarily the distinct experiences and perspectives related to hunting, fishing, cooking, food preparation, and engagement in traditional activities between men and women. There are also notable observations in individuals’ differing perceptions of the distribution of household and food-related duties. This thesis contributes to a growing body of literature, which proves the need for a better understanding of how gender impacts food systems in Inuit communities.Item An Intersectionality-Informed Analysis of Loneliness and Discrimination Experienced by 2S/GBTQ+ People Living With Disabilities Before and During the COVID-19 Pandemic(2024) Amato, Anthony Theodore; Lachowsky, Nathan; Card, KifferIntroduction: Social inequities such as loneliness and discrimination due to sexual orientation (herein, discrimination) are prevalent across disabled people and Two-Spirit, Gay, Bisexual and Trans men, Queer and Non-Binary (2S/GBTQ+) communities. However, little is known about how loneliness and discrimination were experienced in Canada at the intersection of disability and 2S/GBTQ+ communities, especially before and during the COVID-19 pandemic. Method: To address this knowledge gap, four cycles (2019, 2020, 2021, 2022) of cross-sectional, bilingual, community-based Sex Now survey data were used, which included 2S/GBTQ+ people aged 15 years or older and living in Canada. A total of 12,355 2S/GBTQ+ participants responded to loneliness outcomes, and 11,575 to discrimination outcomes. A multi-stage data analysis was conducted. First, crosstabulations and chi-square tests were used to describe and test for differences across outcomes across the four survey cycles. Second, pooled data were analyzed to describe and test for differences in outcomes based on social determinants of health. Third, stratified analyses were repeated for participants living with and without a disability. Finally, only among 2S/GBTQ+ participants living with disabilities, multivariable logistic regression models of each outcome identified 1) temporal trends by survey year, and 2) social determinants of health correlates. Results: There were statistically significant differences in outcomes across survey cycles, which were greater among 2S/GBTQ+ participants living with a disability. Compared with 2019 (before COVID-19), the odds of reporting loneliness were greater for 2S/GBTQ+ participants living with disabilities in 2020 and 2021 (but not 2022). 2S/GBTQ+ participants living with a disability who reported a racialized identity, financial strain, or a gender-expansive identity had greater odds of reporting loneliness. Compared with 2019 (before COVID-19), decreased odds of reporting discrimination were found in 2021 and 2022 (but not 2020). Generally, older 2S/GBTQ+ participants living with a disability were less likely to experience discrimination. 2S/GBTQ+ participants living with disabilities who were racialized, queer versus bisexual identified, and gender-expansive reported greater odds of discrimination. Conclusions: These findings suggest that 2S/GBTQ+ people living with disabilities were impacted by greater loneliness and lesser discrimination during COVID-19. However, social inequities were also present among 2S/GBTQ+ people living with disabilities. Equitable policy planning is needed to ensure that underserved yet deserving communities are not disproportionally affected by future pandemics and associated public health responses.Item Blood Donation in the Era of Biomedical HIV Prevention and Gender-neutral Donor Screening(2024-01-29) Higgins, Robert; Lachowsky, Nathan; Card, KifferObjective. Canada’s implementation of gender-neutral sexual behaviour screening allows sexually active men who have sex with men to donate blood for the first time. Public health campaigns promoting effectiveness of pre-exposure prophylaxis (PrEP) and undetectable = untransmittable (U=U) for HIV prevention heavily target sexual and gender minorities. Donor deferral policies remain in place for both methods. This thesis explores the tension between the effectiveness of these HIV prevention methods and donor policies considering them indicators of HIV risk. Methods. I wrote an algorithm approximating donor eligibility producing two analytic samples; one including PrEP use, one including HIV-negative men using U=U. I then estimate the proportion of donors who would be deferred for each prevention method. Chapter Two uses logistic regression to investigate PrEP use as a motivator for blood donation. Chapter Three describes HIV risk and protective factors for HIV and compares these observations to population health estimates of HIV incidence risk. Results. The algorithm identified n = 2,301 potential donors when PrEP users were included. Of these n = 85 (3.7%) would have been deferred for PrEP use. When repeated with HIV-negative donors using U=U, n= 2,354 donors were identified and n = 53 (2.3%) would have been deferred. PrEP use was not associated with willingness to donate. Estimates of HIV acquisition risk observed in the U=U analytic sample showed high risk of HIV acquisition. Contradictorily, a high number of combination HIV prevention strategies were also observed in the sample. Conclusion. It is likely donors are deferred solely for their choice of HIV prevention method. Having made a past donation was the best predictor of willingness to donate blood. Observed combination HIV prevention strategies employed by the U=U analytic sample did not support high public health estimates of HIV acquisition risk. Future research should explore PrEP adherence in samples of donors deferred for PrEP use and adjusting estimates of HIV acquisition risk to consider PrEP and U=U in risk estimates.Item Pockets of Safety: Implementing an Overdose Prevention Site into an Emergency Shelter During a Public Health Emergency(2023-12-19) Elbassiouny, Katrina; Pauly, Bernadette; Wallace, BruceBackground: In April 2016, after several months of increased numbers of unintentional drug toxicity deaths, British Columbia’s Provincial Health Offer declared a public health emergency in response to this prolonged spike. In December 2016, the BC Minister of Health released Ministerial Order 488, supporting the implementation and expansion of overdose prevention services. In response to the toxic drug policy crisis in BC, one such overdose prevention site (OPS) was implemented within an emergency shelter, in Victoria, BC, in December 2016. This research sought to understand the role of OPS in responses to substance use and harms for people who use drugs and alcohol from the perspective of people accessing the shelter. Interviews were conducted in the spring of 2018, approximately 1.5 years after the OPS was opened. The primary research questions for this study were: How has the implementation of an OPS contributed to responses to substance use and the uptake of harm reduction policy, philosophy, and practice within the shelter, from the perspective of people accessing the shelter? What were the impacts of implementing an overdose prevention site for people accessing the shelter? To answer these broader questions, my specific research questions were: 1. Has the implementation of an OPS influenced responses to substance use in a shelter setting? 2. Has the implementation of an OPS reduced the harms experienced by people accessing the shelter? 3. How have the policies and practices within the shelter and organization impacted the implementation of the OPS? 4. Has the implementation of an OPS influenced the broader uptake and implementation of harm reduction policy, philosophy, and practice within the shelter setting? Methods: This qualitative study utilized an Interpretive Description methodology and is aligned with a social constructivist paradigm. The applied, practice-based orientation of Interpretive Description balances hermeneutic interpretive tradition with descriptive approaches. Participants were recruited by a third party using purposive sampling. Twenty-one participants were interviewed, and all participants had lived experience of substance use (legal or illegal substances) and were accessing services at the emergency shelter at the time of data collection. Accessing the OPS was not a criterion for participation; as such, experience accessing the OPS varied across participants providing deep insights into the implementation and impacts of the OPS in a shelter setting. Qualitative interviews were audio recorded and transcribed verbatim. Data were organized using NVivo software and analyzed using Interpretive Description. Rhodes’ Risk Environment Framework was used to guide the interpretation of findings. Findings: The OPS provided important micro-level pockets of safety for PWUD within the broader organizational context of the shelter as part of the meso-level risk environment. There were many positive impacts of OPS implementation including saving lives, providing novel inhalation services, preventing harms and complications, reducing criminalization, reducing stigma, improving relationships with staff, improving quality of care, and facilitating connections to care. Primary implementation issues include hours of operation, physical space, and privacy. Informal policy and substance use rules, a constantly changing policy environment, inconsistency in the application of rules, consequences of inconsistent application of rules, and a desire for consistency in the application of rules were all aspects of the broader policy context of the shelter that impacted the implementation of the OPS. Several aspects of the broader shelter influenced and were influenced by the implementation of an OPS. These included an organizational culture in transition, staffing within a transitional culture, the criminalization of substance use, and stigma. Lastly, the meso-level economic context of the shelter identified opportunities to further support implementation, including a need for increased resources, and the intersections of economics and safety. Conclusions: The OPS had positive impacts for those accessing it; however, these impacts were largely limited to the OPS itself. While the OPS shifted the micro risk environment for individuals accessing the OPS, the meso environment remained a risk environment in several ways. The novel inhalation service provided important spaces for safety; however, some lingering risks remained. Peer witnessing and eOPS are important adjuncts to OPS services for people who are unable or unwilling to access traditional OPS. Implementing OPS into an organization that serves diverse populations with different substance use goals and needs presents unique challenges. Organizational and funder policies, aligned with principles of harm reduction, are important for the robust implementation of OPS services and the uptake of harm reduction policy, philosophy, and practice. Peers were critical to the success of the OPS, but the inclusion of peers must go beyond service delivery to also include service planning and design. Adequate resourcing is important for the successful implementation of services, and without adequate resources, risk environments can remain. Robust implementation planning is an essential component of successful service implementation and organizational culture change.Item Everyone Deserves a Sanctuary: Alienation as a Barrier to the Health and Healing of Older Women Who Experienced Homelessness(2023-10-05) Fraser, Kendall; Cloutier, Denise; Benoit, CeciliaExperiences of homelessness can result in social exclusion through stigmatization, discrimination, and displacement. Stress from lack of community integration for people who have been homeless can result in poorer health outcomes, including: higher rates of mental illness and chronic physical health conditions, substance dependence, loneliness, and suicide. This may be particularly true for older women who experience multiple intersections of marginalization. However, there is a lack of research that addresses how to facilitate a sense of belonging for and promote the health and healing of older women who have been homeless, and it is unclear what environmental conditions would help these women to transition out of homelessness and into a place of home that is stable, secure, and safe. This thesis stems from a larger community-based qualitative study that explores the experiences of older women who have been homeless and service providers in the homeless-serving sector, with the goal of building priority recommendations for system improvements. My research aims to address two research questions: 1) how have older women been marginalized and rendered invisible within homeless environments; and 2) how do homelessness experiences and environments shape older women’s behaviour? The theoretical frameworks of intersectionality and alienation guided this thesis, focusing on and developing insights into older women’s experiences of stigma and social exclusion and the impacts this marginalization has on their health. My findings derived from a secondary analysis of 11 out of 20 existing qualitative interviews with older women who have been homeless in Victoria, British Columbia, which revealed that older women were marginalized in homeless environments through a lack of safety and autonomy that contributed to high levels of alienation. Alienation prevented the development of a sense of home and belonging after homelessness that in turn impacted older women’s health and wellbeing. The recommendations from this analysis suggest that greater consideration to the concept of therapeutic landscapes for older women after homelessness would offer more opportunity for them to develop a sense of home and belonging. Overall, this project aims to fill a current gap in the literature on the social exclusion and subsequent health outcomes of older women who have experienced homelessness in Canada.Item Exploring the Social Determinants of Health Associated with Sexually Transmitted Infections in Older Women(2023-09-28) Monks, Jordan; Lachowsky, Nathan; Stajduhar, KelliSexually Transmitted Infections (STIs) are on the rise among older women in British Columbia (BC); yet, sexual health research has paid little attention to this population. Similarly, STI prevention, testing, and treatment strategies often concentrate on youth or young adults. This community-based participatory research study examined how and to what extent social determinants influence STI prevention, testing, and treatment among older women (60+) in BC. This includes stigma around older adult sexuality, which is more prevalent in older women and creates barriers to safer sex practices and access to appropriate sexual health services. A mixed- method design, using cross-sectional surveys and interviews with older women across BC, contributed to understanding the sexual health needs of this population. The key themes that influence older women’s STI prevention, testing, and treatment experiences include: 1) knowledge and beliefs, 2) stigma and shame, 3) social determinants of health such as education, access to care without discrimination, and relationships with trust. This research not only contributes to the knowledge base around older women’s social determinants of health in relation to STI-related behaviours, but also provides data to inform recommendations regarding the development of equitable policies, programs, and services that promote the sexual health of older women in BC.Item Navigating Conservative Drug Policy in Ontario's Safe Consumption Sites: A Critical Investigation of Harm Reduction Policy and Practice(2023-02-09) Arlt, Stephanie; Urbanoski, Karen; Mitchell, Lisa MerynAs harm reduction is increasingly integrated into social and health services and programs, it is essential to recognize the tension between healthcare provided by mainstream institutions and the values of harm reduction. Based on ten interviews with frontline staff who work at safe consumption sites in Ontario, Canada, I explore the challenges of providing harm reduction services under the 2018 Progressive Conservative Government’s Consumption Treatment Service (CTS) reform. My study interrogates the sociopolitical assumptions about drugs and drug use within the CTS policy and examines practices of micro-policy implementation by frontline staff. I characterize` harm reduction as an ontological expression rooted in the lived experience of drug use that places value on relationships and depathologizing drug use. I ask how frontline staff respond to the CTS policy if it changes their understanding and practice of harm reduction and how the policy is accommodated, refused, and disrupted? To answer these guiding questions, I turn my attention to investigating Policy Navigation Practices (PNP) which I define as the creative discretion staff use to balance policy implementation in their encounters with guests. I apply critical medical anthropology theory and methodology to analyze public health policy and services for people who use drugs. This research illuminates the gulf between the lived experience of drug use and the Ontario provincial government’s response to the overdose crisis. I prioritize how networks of care emerge in relation to and are embedded into, sociopolitical contexts that force these practices of care into existence. I situate Safe Consumption Sites (SCS) under the CTS policy as a microcosm of two conflicting worldviews about substance use, ideas of health, and forms of care. The findings advance our understanding of policy implementation practices in SCS and harm reduction as a form of care.Item White Settler Racial Caucusing: Exploring How and to What Extent Racial Caucusing Motivates White Settlers to Address Indigenous-specific Racism(2023-01-03) Devereaux, Fiona; Hancock, Rob; Harding, LaurieThis mixed-method study involving white settler staff in the Faculty of Human and Social Development at the University of Victoria explored how and to what extent racial caucusing motivates white settlers to address Indigenous-specific racism within post-secondary institutions. Educational institutions have long-standing colonial practices that perpetuate racism while denying and disrespecting Indigenous human rights. This research responded to legislation and documentation calling for settler societies to be held accountable and to take actions on Indigenous-specific racism. White settlers can play a critical role in disrupting Indigenous-specific racism. Through a six-session intervention to address Indigenous-specific racism, this study showed that white settler caucusing transforms white settler racial identity and supports changes in colonial thoughts and behaviours. Three themes emerged: critical reflexivity, relational accountability, and responsibility. Outcomes included racial caucusing curriculum was new and limited time had been spent exploring settler colonialism and whiteness previously. Participants shared they had increased understanding that the burden of responsibility to address Indigenous-specific racism should be on white settlers’ shoulders and that Indigenous-specific racism is created by systems and structures of whiteness that privilege white settlers and erase and silence Indigenous peoples. As a result of this intervention, participants developed a deeper connection to their identity as a white settler in that who they are has provided them with social, political, and economic meaning and benefits. This research has the potential to provide a possible pathway for targeted, focused, and accountable learning for white settlers as a part of their scaffolded Indigenous anti-racism learning journey.Item An intersectional exploration of alternative menstrual management strategies amongst menstruators in a Canadian context(2022-12-22) Majewski, Courtney; Clark, Nancy; Cacchioni, TheaIn this thesis I work to understand what factors influence low-income menstruators' decisions to use alternative menstrual management strategies in the Canadian context. In order to provide a critical review of the factors associated with period poverty, I conduct an exploratory and critical analysis of how intersecting aspects of identity and social location influence diverse low-income menstruators’ decision to use alternative menstrual management strategies. A short survey and semi-structured interviews were conducted with menstruators who use alternative menstrual management strategies. Through the thematic reflexive analysis, the qualitative data suggests that menstruation is a multifaceted experience, that is dependent on a number of diverse, personal, and variable factors. The findings indicate that menstrual management decisions by low-income menstruators are motivated by a number of factors including improved practical management of menstrual bleeding, the mitigation of menstrual management related stress and pain, as well as stigma and de-stigmatization. Contextual factors that support low-income menstruators manage their menstruation include receiving period-positive and comprehensive menstrual education, having access to supportive relationships, and having access to the financial and emotional resources.Item Elders Living with Dementia: Nuu-Chah-Nulth First Nations Family Perspectives on Elder Healthcare(2022-09-21) Aro, Cheryl Lavern; Brown, Leslie; Morgan, JennyIn Canada, the literature regarding First Nations people’s experiences with dementia is sparse, as is the literature relating to the health and wellness of Indigenous dementia caregivers. Colonization has imposed physical, psychological and structural disadvantages on Indigenous communities that impact the family’s ability to provide informal dementia care. The First Nations senior population is growing rapidly and there is a pressing need to gather knowledge about the unique needs of First Nations informal dementia caregivers. This doctoral research seeks to contribute to the growing body of literature on this vitally important topic. This thesis reports the findings from my PhD research study, which was conducted in collaboration with the Nuu-Chah-Nulth Tribal Council, and with generous support from the Nuu-Chah-Nulth community. Using an Indigenous storytelling research method, the study explored the following questions: What are the experiences of Nuu-Chah-Nulth First Nations dementia caregivers? What support services do caregivers access and what services do they perceive are lacking? Nine Nuu-Chah-Nulth caregivers shared their experiences providing support and care to a family member with memory loss, and their perspectives on memory care resources. Interviews were conducted in various locations within the Nuu-Chah-Nulth territories to gather the caregiver’s knowledge. The author’s story as an informal dementia caregiver is also interwoven throughout the dissertation. The Nuu-Chah-Nulth caregivers narratives revealed diverse and complex experiences with the following central themes and sub-themes: trauma over the life-cycle (residential school, family violence, grief and loss); pressures of care-giving (managing the symptoms of dementia, health and family dynamics); and finally, participants’ perceptions of community resources. The findings from this research reveal that Nuu-Chah-Nulth dementia caregivers and the family members they supported were still healing from the various traumas that were inflicted on their mind, body and spirit through residential school experiences. Most of the caregivers reported that they prefer to care for their family member at home but community supports are limited.Item "Crisis" in the Four Pillars: A Mixed Methods Discourse Analysis of Human Security and Overdose in BC(2022-09-07) Fraser, James; Urbanoski, Karen; Greaves, WillThe crisis of overdose deaths in British Columbia (BC) continues into its seventh year. This thesis applies a human security lens to a mixed methods computer-assisted discourse analysis on a corpus of public-facing documents from drug enforcement organizations in BC, and one from community-run harm reduction organizations in BC. Analysis uses a “What is the Problem Represented to Be”? (WPR) approach to analyze conflicting conceptual logics and answer the question “What human security problems are constructed in Harm Reduction and Enforcement discourses surrounding the crisis of overdose deaths in British Columbia?” Conclusion: Both corpora construct different problematizations. Whereas enforcement discourses emphasize criminality and proximal substance use harms, harm reduction discourses look at enforcement as a structural threat to people who use drugs.Item Utility of electronic decision-support tools for patients with head and neck cancer(2022-04-29) Stringer, Eleah; Kushniruk, Andre W.; Lum, Julian J.Background: Patients with head and neck cancer (HNC) carry a clinically significant symptom burden, alterations in function (e.g. impaired ability to chew, swallow, and talk), and decrease in quality of life. Furthermore, treatment impacts social activities and interactions as patients report reduced sexuality and high rates of depression. Patients may suffer undue anxiety because they find treatment incomprehensible, which is partially a function of limited, understandable information. This can be particularly challenging for patients with limited health literacy. Furthermore, a globalized world consisting of cultural differences increases the need to enhance transparent communication of risk. Research on risk literacy and medical decision-making validates that across different cultures, people often have severe obstacles in grasping a host of prerequisite concepts for understanding health-related risk information such as numbers, graphs, and basic medical facts. Patients’ perceptions of having obtained adequate information prior and during treatment are predictive of positive outcomes. Providing patient-centered decision-support, utilizing visual images, may increase understanding of treatment options and associated risks to improve satisfaction with their decision and consultation, while reducing decisional conflict. A scoping review was conducted on electronic, decision aids (DAs) for oncology patients that returned 4217 articles, but only 167 for HNC, with 12 meeting the inclusion criteria. Three themes were identified: (1) both patients and physicians valued the DA; (2) DAs should be visually supported by images; and (3) use of a DA lessened decisional conflict and anxiety while improving knowledge, satisfaction and shared decision-making. This informed the design of a prototype DA. Semi-structured interviews were conducted with 12 survivors of HNC who completed treatment at BC Cancer- Victoria on their experiences, feedback on the utility of a DA, and insights into design features. Thematic analysis resulted in 12 themes that were organized into 3 categories. The first category, “the patient experience,” included three themes: “patients have high, through varying information needs”; “an emotional experience”; and “stories of coping, strength and resiliency.” The second category, “electronic DAs and decision support,” also included three themes: “familiarity with decision aids”; “support of concept: usefulness and of visual aids”; and “versatility of the prototype.” The last category, “evaluation of prototype”, contained six themes: “reaction to prototype”; “favourited features”; “complexity”; “preference for customizability”; “suggestions for improvement”; and “presentation device.” Key Message: The use of DAs have been shown to better inform and increase patients’ knowledge, accuracy of risk perception, and congruency between informed values and care choices allowing them to take part in active decision-making, compared to usual care. Survivors of HNC were in unanimous support of using visual images to help explain treatment and assist in decision making on treatment options. Furthermore, they contributed invaluable feedback on the prototype design, demonstrating the value of a co-design methodologies.Item COVID-19 and pregnant and parenting women who use drugs: exploring the impact of stigmatization on help-seeking behaviour(2022-04-28) Nichol, Emily; Urbanoski, Karen; Pauly, BernieStigma surrounding substance use has been documented as a roadblock to recovery, posing a greater barrier to care for some populations more than others. In particular, pregnant and parenting women are an often overlooked and understudied demographic who could benefit considerably from targeted resources. Though, due to stigma surrounding substance use and motherhood, this demographic is routinely subject to judgement and discrimination resulting in delayed treatment entry. In the midst of the COVID-19 pandemic, issues of access have been compounded by a reduction in services despite heightened mental health struggles caused by prolonged periods of isolation and abrupt changes in lifestyle and environment. The purpose of this study is to understand how stigmatization affects help-seeking behaviour and to explore the impact of COVID-19 on women’s mental health and treatment experiences. Semi-structured telephone interviews were conducted from October 2020-February 2021, with current and past clients of integrated treatment programs in Ontario (n=24). Using an interpretive description approach, data was constructed to identify how stigma is internalized, anticipated, and embodied in the context of help-seeking behaviour, as well as to determine the extent to which the pandemic has interfered with maternal wellbeing. The following themes emerged: (1) stigma and help-seeking (2) COVID-19 and maternal wellness (3) stigma at the structural level: barriers to care and (4) mitigating stigma to enhance help-seeking: facilitating recovery through relationships. This research contributes evidence to a growing body of literature emphasizing the importance of relationships in the recovery process for combatting the effects of stigma and promoting early treatment entry and lends insight into the ways in which pregnant and parenting women with problematic substance use have navigated recovery during COVID-19.Item The experience of ostomy surgery in young women with inflammatory bowel disease(2022-02-11) Clark, Ashley; Smith, André; Sheets, Debra J.Background: Inflammatory Bowel Disease (IBD) is a chronic, relapsing, autoimmune disease, affecting one in every 150 Canadians. Failure to induce remission of IBD with pharmacotherapy can necessitate surgical interventions, such as the creation of an ostomy. Ostomy surgery can help manage severe IBD and thus improve quality of life; however, individuals living with IBD report the possibility of ostomy surgery as a top concern, which can lead them to refuse or delay this decision until the disease becomes life threatening. Research Objective: The aim of this study is to understand what factors influence the decision to have ostomy surgery in young women with IBD, how the perception of the surgery compares to the reality of living with an ostomy, and the role healthcare professionals play in this decision. Methods: Nine participants who (1) identify as female, (2) are between the ages of 19 and 30, and (3) are currently living with an ostomy to treat IBD were recruited for this study. Additionally, seven healthcare professionals who work with IBD patients were recruited. Participants were invited for an individual, semi-structured interview. Findings: Young adult women living with an ostomy to treat their IBD reflected on their initial fears and concerns about undergoing surgery. Due to the severity of their illness, the majority of participants had requested surgery after having some time to adjust to the idea. This request, however, was often met with resistance or obstacles in the healthcare system. Healthcare professionals share mixed perceptions of ostomy surgery, with some viewing it as a last resort and others perceiving it as a treatment option. Once surgery had been performed, young adult women describe some challenges adjusting to life with an ostomy; but the majority report experiencing an overall improvement in quality of life. Conclusion: Understanding the perceptions that influence how young women perceive ostomies prior to versus after surgery will help identify the factors that influence the decision-making process for ostomy surgery, such as gender, age and stigma. Challenging current beliefs and assumptions may allow more supportive conversations between healthcare professionals and patients and provide insight on the actual lived experience of young women living with an ostomy.Item A feminist post structural analysis of trauma informed care policies in BC(2021-09-17) Seeley, Terri-Lee; Strega, Susan; Worthington, CatherineMy study examines trauma informed practice (TIP) policies in BC, Canada. My chosen methodology, what is the problem represented to be (WPR) (Bacchi 2009), makes politics visible in policies. I am interested in the effects of trauma policies on women who experience male violence. How does discourse produce certain effects and constitute specific subjects within these texts? I extend a politicized analysis of TIP policies, specifically, an in-depth feminist post structural analysis. I advance an understanding of the effects of policy, particularly for women who have experienced male violence and who receive services under the TIP guidelines. I note the absence of an intersectional analysis and the lack of attention paid to power relations, specifically associated with the provision of care within the health care system, the construction of the traumatized female subject and the absence of a social justice lens in TIP policies. My study addresses the meanings, and resulting practices arising from the TIP policy and its impacts on women's lived experiences. My feminist post structural analysis provides a critique of TIP policies glaringly absent from the literature. I examine available literature, which evaluates TIP. My analysis deepens the understanding of the policy's inherent assumptions by revealing the problem of trauma, as represented in TIP policies. I explore the emergence of the dominant concept of trauma in the completion of a genealogy of trauma. I uncover the commonly accepted trauma ethos, a set of principles and beliefs about violence against women that has set the path for a trauma discourse in BC's guidelines, policies, and programs. I explore my interest in iv the ontology of trauma, the nature of trauma itself and the way of being when trauma has occurred. While exploring this interest through a genealogy of trauma, I identify five historical figures; the traumatized female figure, the assaulted woman figure, the wounded veteran figure, the colonized Indigenous woman figure and the emancipated woman figure. My study explores how women are obscured and invisible in policies intended to address violence against women. I demonstrate that this invisibility results in gender-neutral policies-if there is no gender-based violence- we, therefore, do not have to think of gender-based treatment. The patriarchal erasure of women from trauma policies continually repositions what the problem is represented to be. These policies constitute women as the less valued subjects, fundamentally damaged and flawed. Trauma policies shape women as people who can damage staff; assuming they are a source of trauma infection; they can infect staff with their trauma resulting in vicarious traumatization of staff. Trauma policies characterize the traumatized female subject as fundamentally different from the staff or the professional expert. Only certain kinds of women can be traumatized, the mentally ill and substance-using women. My study exposes the presupposition embedded in policies that only certain women are violated, and other women are unlike them. This trauma discourse is grounded in racism, colonialism and sexism, built on stereotypical patriarchal representations of women, resulting in the stigmatization of women who experience male violence.Item “Day by day: coming of age is a process that takes time”: supporting culturally appropriate coming of age resources for urban Indigenous youth in care on Vancouver Island(2021-07-16) Mellor, Andrea Faith Pauline; Cloutier-Fisher, Denise S.; Kobayashi, Karen M.The Truth and Reconciliation Commission’s first call to action is to reduce the number of Indigenous children and youth in care, including keeping young people in culturally appropriate environments. While we work towards this goal, culturally appropriate resources are needed to support children and youth as evidence shows that when Indigenous youth have access to cultural teachings, they have improved physical, mental, emotional, and spiritual health outcomes. Our project focused on the protective qualities of Indigenous coming of age teachings. Together with our community partner Surrounded by Cedar Child and Family Services, we worked to develop resources that inform and advocate for a culturally-centered coming of age for urban Indigenous youth living in foster care in Victoria, British Columbia on Lekwungen Territory. This dissertation begins with a literature review to provide the social and historical context surrounding urban Indigenous youth-in-care’s access to coming of age teachings. This is followed by a description of the Indigenous research paradigm that guided our work, what it meant for us to do this project in a good way, and the methods that we used to develop three visual storytelling knowledge sharing tools. Three manuscripts are presented, two published and one submitted, that reflect a strength-based vision of coming of age shared by knowledge holders who participated in our community events. The first manuscript retells the events of the knowledge holder’s dinner, where community members shared their perspectives on four questions related to community engagement and youth support. An analysis of the event’s transcripts revealed key themes including the responsibility of creating safe-spaces for youth, that coming of age is a community effort, and the importance of youth self-determining their journey. A graphic recording and short story are used to illustrate and narrate the relationship between key themes and related signifiers. This manuscript highlights the willingness of the community to collectively support youth in their journeys to adulthood. The second manuscript focuses on our two youth workshops that had the objective of understanding what rites of passage youth in SCCFS’s care engage with and how they learn what cultural teachings were most important to them. The findings suggest that when youth experience environments of belonging, and know they are ‘part of something bigger’, qualities like self-determination, self-awareness, and empowerment are strengthened. The third manuscript focuses on how we translated our project findings into different storytelling modalities using an Indigenist arts-based methodological approach. The project findings provided the inspiration and content for a fictional story called Becoming Wolf, which was adapted into a graphic novel, and a watercolour infographic. These knowledge sharing media present our project findings in accessible and meaningful ways that maintain the context and essences of our learnings. This research illustrates how Indigenous coming of age is an experience of interdependent teachings, events, and milestones, that contribute to the wellness of the body, mind, heart, and spirit of youth and the Indigenous community more broadly. Through our efforts, we hope to create a shared awareness about the cultural supports available to urban Indigenous youth that can contribute to lifelong wellness.