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Item Major Project Literature Review Workbook: Master of Education in Indigenous Language Revitalization (MEd MILR) – IED 594: Research Proposal and Literature Review(2025-07) Russell, Pia; Czaykowska-Higgins, Ewa; Restoule, Jean-PaulAn in-depth workbook for students of the Master's of Indigenous Language Revitalization (MILR) program taking the required course, IED594: The Research Proposal and Literature Review. This workbook was developed by Librarian Pia Russell and Professors Ewa Czaykowska-Higgins and Jean-Paul Restoule.Item Understanding how self-management interventions work for disadvantaged populations living with chronic conditions: Protocol for a realist synthesis(BMJ Open, 2014) Mills, Susan L.; Pumarino, Javiera; Clark, Nancy; Carroll, Simon; Dennis, Sarah; Koehn, Sharon; Yu, Tricia; Davis, Connie; Fong, MayleneIntroduction Self-management programmes are complex interventions aimed at improving the way individuals self-manage chronic conditions, but there are questions about the overall impact of these programmes on disadvantaged populations, in terms of their capacity to engage with and receive the benefits from these initiatives. Given the increased resources being directed towards self-management initiatives, clinicians and policy makers need knowledge on how self-management interventions work for these populations. Most systematic reviews of self-management interventions do not consider the complex interactions between implementation contexts, intervention strategies, and mechanisms that influence how self-management interventions work in real life for disadvantaged groups. Methods To address the need for better understanding of these mechanisms and to create context-relevant knowledge, we are conducting a realist synthesis of evidence on self-management interventions for disadvantaged populations living with chronic conditions. The primary research question is: What are the key mechanisms operating in chronic condition self-management interventions among disadvantaged populations? In this protocol, we outline the steps we will take to identify the programme theory for self-management interventions and candidate middle-range theories; to search for evidence in academic and grey literature; to appraise and extract the collected evidence; to synthesise and interpret the findings to generate key context-mechanism-outcome configurations and to disseminate results to relevant stakeholder and to peer-review publications. Dissemination Understandings of how chronic conditions self-management interventions work among disadvantaged populations is essential knowledge for clinicians and other decision makers who need to know which programmes they should implement for which groups. Results will also benefit medical researchers who want to direct effort towards current gaps in knowledge in order to advance the self-management field. In addition, the study will make a contribution to the evolving body of knowledge on the realist synthesis method and, in particular, to its application to behaviour change interventions for disadvantaged populations.Item Upscaling integrated mental health services and systems for people of forced migration(Open Access Government, 2024) Clark, NancyHow can realist impact evaluation be used to upscale the integration of mental health programs for people of forced migration? Nancy Clark, an Associate Professor from the University of Victoria, investigates. Forced migration, displacement, and resettlement can be considered determinants of migrant mental health. Migrants are people who experience migration and/or forced displacement across or within national borders, e.g., refugees, asylum seekers, the undocumented, people who require temporary or permanent protection. (IOM Glossary on Migration, 2019).Item Exploring community capacity: Karen refugee women’s mental health(International Journal of Human Rights in Healthcare, 2018) Clark, NancyPurpose– The purpose of this paper is to describe Karen refugee women’s experience of resettlement and the factors which structured community capacity to support their mental health and well-being. Design/methodology/approach– A postcolonial and feminist standpoint was used to bring Karen women’s voice to the knowledge production process. Data were collected through ethnographic field observation, in-depth semi-structured individual and focus group interviews with Karen women as well as healthcare and social service providers. Findings– Three interrelated themes emerged from the data: Karen women’s construction of mental health as “stress and worry”; gender, language and health literacy intersected, shaping Karen women’s access to health care and social resources; flexible partnerships between settlement agencies, primary care and public health promoted community capacity but were challenged by neoliberalism. Research limitations/implications– Karen women and families are a diverse group with a unique historical context. Not all the findings are applicable across refugee women. Practical implications– This paper highlights the social determinants of mental health for Karen women and community responses for mitigating psychological distress during resettlement. Social implications– Public health policy requires a contextualized understanding of refugee women’s mental health. Health promotion in resettlement must include culturally safe provision of health care to mitigate sources of psychological distress during resettlement. Originality/value– This research brings a postcolonial and feminist analysis to community capacity as a public health strategy.Item How can photography help refugee men talk about mental health?(Futurum, 2024-01-04) Clark, NancyRefugees face many threats to their mental health, from the trauma of being forced to leave their home, to the loneliness, financial insecurity and discrimination they may face in their new country. At the University of Victoria in Canada, Dr Nancy Clark has been working with Syrian refugee men to explore their experiences of resettling into life in a new country. The team is using photography to understand Syrian refugee men’s experiences of integration, employment and affects to their mental health.Item Applying critical race feminism and intersectionality to narrative inquiry: A point of resistance for Muslim nurses donning a hijab(Advances in Nursing Science, 2019) Clark, Nancy; Saleh, NasrinRacism in nursing can be positioned through institutional forms of gendered, racialized, and religious structures. Muslim nurses who choose to honor the Islamic practice of donning hijab may be at risk of experiencing racism in contexts of post–September 11 era and the war on terror. Critical race feminism and intersectionality are theoretical frameworks that when applied to narrative inquiry can illuminate the standpoint of Muslim nurses donning hijab by providing a counternarrative as a point of resistant to racism in nursing.Item Quality of patient, family, caregiver and public engagement in decision-making in healthcare systems: A scoping review protocol(BMJ Open, 2019) Hamilton, Clayon; Snow, M. Elizabeth; Clark, Nancy; Gibson, Shannon; Dehnadi, Maryam; Lui, Michelle; Koster, Andrew; McLean, Janet; Li, Linda C.Introduction To advance person- and family-centred healthcare, government initiatives have supported the engagement of patients and family caregivers in decision-making in healthcare systems. There is, however, no consensus on how to define success for such initiatives. This scoping review aims to identify the key elements for defining the quality of patient and family caregiver engagement in decision-making across the engagement domains (individual, community/organisation, system) of British Columbia’s healthcare system. We will use those elements to develop a conceptual evaluation framework. Methods and analysis This scoping review follows Arskey and O’Malley’s methodology. (1) The research question was identified through team discussions. (2) Articles for data source will be identified using a librarian-informed search strategy for seven bibliographic databases as well as grey literature sources. (3) Selected articles will be relevant to the evaluation of patient and family caregiver engagement in healthcare systems. (4) Two researchers will independently extract data into predefined and emerging categories. (5) The researchers will reconcile and organise the identified elements. The research team’s collective perspective will then refine the elements, and select, interpret and summarise the results. (6) Persons from key stakeholder groups will be consulted to refine the emergent conceptual framework. Ethics and dissemination We will seek ethics approval for the stakeholder consultation. This study follows an integrated knowledge translation approach. The results will inform evaluation of the Patients as Partners Initiative of the British Columbia Ministry of Health, and will be disseminated as a scientific article, a research brief, and presentations at conferences and stakeholder meetings.Item Religion and spirituality in the context of bipolar disorder: A literature review(Mental Health, Religion & Culture, 2011) Pesut, Barbara; Clark, Nancy; Maxwell, Victoria; Michalak, Erin E.Bipolar disorder (BD) affects approximately half a million Canadians. Religion and spirituality (R/S) may play an important role for individuals with BD by providing a means of coping with, and an explanatory model for, their disorder. We conducted a systematic review of empirical studies that have explored R/S in individuals with BD or samples that explicitly delineate individuals with BD. Only six studies met our inclusion criteria. Findings from these studies suggest that R/S strategies may be important for some people in the management of BD. Religion and spirituality thus become relevant concerns for a therapeutic regime that seeks to develop wellness within a bio-psycho-social model. However, the limited body of research and methodological shortcomings of existing research make it difficult to draw relevant conclusions about how this might be accomplished. The authors propose a need for longitudinal, prospective, mixed methods research in order to inform evidence-based practice.Item Themes for evaluating the quality of initiatives to engage patients and family caregivers in decision-making in healthcare systems: A scoping review(BMJ Open, 2021) Hamilton, Clayon B.; Dehnadi, Maryam; Snow, M. Elizabeth; Clark, Nancy; Lui, Michelle; McLean, Janet; Mamdani, Hussein; Kooijman, Allison L.; Bubber, Vikram; Hoefer, Tammy; Patients as Partners Team; Li, Linda C.Objective: To identify the key themes for evaluating the quality of initiatives to engage patients and family caregivers in decision-making across the organisation and system domains of healthcare systems. Methods: We conducted a scoping review. Seven databases of journal articles were searched from their inception to June 2019. Eligible articles were literature reviews published in English and provided useful information for determining aspects of engaging patients and family caregivers in decision-making to evaluate. We extracted text under three predetermined categories: structure, process and outcomes that were adapted from the Donabedian conceptual framework. These excerpts were then independently open-coded among four researchers. The subsequent themes and their corresponding excerpts were summarised to provide a rich description of each theme. Results: Of 7747 unique articles identified, 366 were potentially relevant, from which we selected the 42 literature reviews. 18 unique themes were identified across the three predetermined categories. There were six structure themes: engagement plan, level of engagement, time and timing of engagement, format and composition, commitment to support and environment. There were four process themes: objectives, engagement approach, communication and engagement activities. There were eight outcome themes: decision-making process, stakeholder relationship, capacity development, stakeholder experience, shape policy/service/programme, health status, healthcare quality, and cost-effectiveness. Conclusions: The 18 themes and their descriptions provide a foundation for identifying constructs and selecting measures to evaluate the quality of initiatives for engaging patients and family caregivers in healthcare system decision-making within the organisation and system domains. The themes can be used to investigate the mechanisms through which relevant initiatives are effective and investigate their effectiveness.Item Applying intersectionality with constructive grounded theory as an innovative research approach for studying complex populations: Demonstrating congruency(International Journal of Qualitative Methods, 2020) Kassam, Shahin; Marcellus, Lenora; Clark, Nancy; O’Mahony, JoyceOne goal of qualitative health research is to fully capture and understand stories of people who experience inequities shaped by complex interlocking structural and social determinants. With this social justice–oriented goal in mind, it is critical to use a methodological approach that appreciates prevailing inequities and oppression. In this article, we propose an innovative approach that joins qualitative health research methodology with critical inquiry. Specifically, we propose advancing constructive grounded theory (CGT) through applying intersectionality as an emergent critical social theory and an analytical tool. With our proposed approach being novel, minimal attempts to conceptualize and operationalize CGT with intersectionality exist. This article focuses on initiating theoretical conceptualization through focusing on demonstrating congruency. We are guided by this focus to seek connectedness and fit through analyzing historical and philosophical assumptions of CGT and intersectionality. In our article, we demonstrate congruency within four units of analysis: reflexivity, complexity, variability, and social justice. Through these units, we offer implications to applying intersectionality within CGT methodology. These include a foundation that guides researchers toward further conceptualizing and operationalizing this novel research approach. Implications also include innovatively exploring complex population groups who face structural inequities that shape their lived vulnerabilities. Our proposed research approach supports critical reflection on the research process to consider what shapes the researcher–participant relationship. This includes reflecting on analysis of power dynamics, underlying ideologies, and intermingling social locations. Thus, our conceptual paper addresses the call for evolving social justice methodologies toward inquiring into complex populations and generating knowledge that challenges and resists inequity.Item Neonatal nursing research in low-and middle-income countries: A scoping review(Journal of Neonatal Nursing, 2024) Amundsen, Miranda M. M.; Little, Matthew; Clark, Nancy; Marcellus, LenoraNeonatal outcomes contribute over 50% to under-five child mortality globally. Given that nurses in low- and lower-middle-income countries are often primary care providers, they are ideally positioned to impact outcomes. Our scoping review aims to explore how neonatal nurses in LMICs are represented in global health research. Methods: This review was constructed using Arksey and O’Malley’s five-step framework. Five databases were utilized in the search, and grey literature was included. Results: A total of 651 articles were yielded, with 31 included in our review. We constructed themes based on the philosophical conceptualization of nursing knowledge as knowledge about nursing, knowledge for nursing, and knowledge of nursing. Conclusion: Representation of neonatal nursing in LMIC in global health research is extremely limited. Literature that exists primarily describes challenges in neonatal nursing or provides practice-specific knowledge for nurses to utilize. Further, research exploring knowledge of nurses that does exist has been entirely driven by Western, non-nursing perspectives.Item Exploring Syrian men's mental health and participation in labor employment: A community participatory arts-based project(Voices Against Torture, International Journal on Human Rights, 2021) Clark, NancyBackground: Refugee men experience significant discrimination and violence throughout their migration journey. Discrimination and violence do not end once refugees are received into third-country nation-states. Resettlement is recognized as a key protection tool for refugees to ensure protection and well-being, but only if their gendered specific needs are recognized and addressed. Research and policy on refugee integration tend to adopt a gender mainstreaming approach to address inequities across gender(s) but have primarily focused on refugee women Clark and Vissandjée (2019).Item Equity promoting integrated care: Definition and future development(International Journal of Integrated Care, 2023) Wankah, Paul; Gordon, Dara; Shahid, Simone; Chandra, Shivani; Abejirinde, Ibukun-Oluwa; Yoon, Rosanra; Wodchis, Walter P.; O’Campo, Patricia; Gray, Carolyn Steele; Clark, Nancy; Shaw, JamesOver the last three decades, integrated care has emerged as an important health system strategy to improve population health while addressing the unique needs of structurally marginalised communities. However, less attention has been given to the role of integrated care in addressing issues related to inequities in health and health care. In this commentary we introduce the concept of Equity Promoting Integrated Care (EPIC) that situates integrated care in a social justice context to frame the actions necessary to center equity as a priority for integrated care. We suggest that efforts to advance the design and implementation of integrated care should focus on three avenues for future research and practice, namely, the collaborative mobilization of a global network of integrated care stakeholders to advocate for social justice and health equity, investing in equity-focused approaches to implementation science that highlight the importance of social concepts such as colonialism and intersectionality to advance the theory and practice of implementing EPIC models of care, and leveraging innovative approaches to measuring equity-related aspects of integrated care to inform continuous improvement of health systems.Item Front‐liners on the sidelines: The credential recognition experiences of Filipino internationally educated nurses(Canadian Public Administration, 2025) Leonida, Micah; Krawchenko, Tamara; Clark, NancyCommunities across Canada face a shortage of medically trained professionals, the majority of which are nurses, as domestic supply has not kept pace with increasing demand for services. Alongside rising inflation, housing costs, and living expenses, persistent educational and accreditation inequities have created barriers and challenging contexts for internationally educated nurses (IENs) who aim to settle, integrate, and complete professional recertification processes to become registered nurses. This study explores the lived experiences of educational and accreditation factors from the perspective of fifteen recently migrated Filipino IENs in Victoria, British Columbia. Findings suggest that Filipino IENs experience financial and time barriers and deskilling which are part of an overarching theme of their credential recognition experience. The study offers policy recommendations for more equitable recertification pathways including provision of accessible information support pre‐ and post‐arrival and increased collaboration between clinical practice programs. Les communautés du Canada sont confrontées à une pénurie de professionnels formés à la médecine, dont la majorité sont des infirmières, car l'offre nationale n'a pas suivi le rythme de la demande croissante de services. Outre la hausse de l'inflation, du coût du logement et des frais de subsistance, les inégalités persistantes en matière d'éducation et d'accréditation ont créé des obstacles et des contextes difficiles pour les infirmières formées à l'étranger (IFE) qui cherchent à s'installer, à s'intégrer et à compléter les processus de re certification professionnelle pour devenir des infirmières autorisées. Cette étude explore les expériences vécues des facteurs liés à l'éducation et à l'accréditation du point de vue de quinze IEN philippins ayant récemment émigré à Victoria, en Colombie‐Britannique. Les résultats suggèrent que les IEN philippins font face à des obstacles financiers et temporels et à une déqualification qui font partie d'un thème général de leur expérience de reconnaissance des titres de compétences. L'étude propose des recommandations de politiques pour des voies de re certification plus équitables, y compris la fourniture d'un soutien d'information accessible avant et après l'arrivée et une collaboration accrue entre les programmes de pratique clinique.Item The association of the quality of life with Afghan households’ food insecurity before and after the recent political change in Afghanistan: A comparative analysis(BMC Public Health, 2023) Saif-Nijat, Jumakhan; Pakravan-Charvadeh, Mohammad Reza; Gholamrezai, Saeed; Rahimian, Mehdi; Lane, Ginny; Béland, Daniel; Koc, Mustafa; Clark, Nancy; Omidvar, Nasrin; Sadeghi, Rasoul; Vatanparast, HassanThe overreaching objective of the current study is to investigate the association of quality of life with Afghan households’ food insecurity. The data was collected immediately after the Taliban took control of a large part of Afghanistan. About a total of 555 households’ heads participated in a face-to-face interview, using the HFIAS and WHOQOL-100 questionnaires along with some questions related to their socioeconomic characteristics at two different times, before and after the Taliban’s takeover. The comparative analysis showed that 98% of Afghan households were food insecure after the Taliban takeover, while 70% of them faced food insecurity before the Taliban’s takeover. The quality of life in the Taliban era is worse than before the Taliban. All dimensions of quality of life have decreased, and this decrease was more pronounced for the psychological, environmental, and physical domains. It is recommended that international organizations, NGOs, and local agents focus on these dimensions of the quality of life to improve food security.Item Use of participatory action research to support Syrian refugee mothers in the resettlement period in Canada: A longitudinal study(PLoS ONE, 2023) O’Mahony, Joyce; Kassam, Shahin; Clark, Nancy; Asbjoern, TrichiaResearch has shown that refugees in a foreign country often experience physical and mental health challenges upon resettlement (Ahmad et al., 2021; Salam et al., 2022). In Canada, refugee women experience a range of physical and mental barriers, including poor access to interpreter services and transportation, and a lack of accessible childcare, all of which can negatively affect their successful integration (Stirling Cameron et al., 2022). Social factors that support Syrian refugees to settle successfully in Canada have been unexplored systematically. This study examines these factors from the perspectives of Syrian refugee mothers living in the province of British Columbia (BC). Framed by principles of intersectionality and community-based participatory action research (PAR), the study draws on Syrian mothers’ perspectives of social support in early, middle, and later phases of resettlement. A qualitative longitudinal design consisting of a sociodemographic survey, personal diaries, and in-depth interviews was used to gather information. Descriptive data were coded, and theme categories were assigned. Six themes emerged from data analysis: (1) Steps in the Migration Journey; (2) Pathways to Integrated Care; (3) Social Determinants of Refugee Health; (4) COVID-19 Pandemic Impacts and Ongoing Resettlement; (5) Strength-Based Capabilities of Syrian mothers; (6) Peer Research Assistant’s Research (PRAs) Experience. Results from themes 5 and 6 are published separately. Data obtained in this study contribute to the development of support services that are culturally appropriate and accessible to refugee women living in BC. Our objectives are to promote the mental health and improve the quality of life of this female population, and to enable it to access healthcare services and resources in a timely manner.Item Factors supporting settlement among Syrian refugee women: A longitudinal participatory action research study(International Health Trends and Perspectives, 2023) Kassam, Shahin; O’Mahony, Joyce; Clark, NancyIntroduction: Over 13 million Syrians have been forcibly displaced since the start of the Syrian civil war in 2011. In response to this humanitarian crisis, several high-income countries have settled thousands of Syrian refugees. In Canada, over 50,000 Syrian refugees have resettled through varying resettlement programs. Half of the refugees are women who are mothers or of child-bearing age, and who experience numerous health disparities. This article reports findings from a larger, Canadian-based study inquiring into the factors supporting and shaping the settlement and integration experiences among women who are Syrian refugees and mothering. Methods: A longitudinal intersectionality-framed participatory action approach was initiated through multiple meetings with a diverse range of non-profit community organizations focused on refugee health and settlement. Through these meetings, sustainable relationships were formed, and trust was built toward further engaging with the Syrian refugee mothering women population. A core group of 4 women were employed as peer research assistants and were integrated across research processes. Results: In total, 40 Syrian refugee mothering women participated in this study. Six themes emerged from data analysis of their lived experiences of resettlement. Four of these themes are published elsewhere. We focus this article on two of the six key findings: harnessing strength-based capabilities, and peer research assistant experiences. Conclusions: The two findings described in this article convey facilitators that add to understanding influences on the mental well-being of Syrian refugee mothering women. Unique to this study is the novel integration of peer research assistants and a model of support which contributes to an ethical and inclusive approach to understanding lived experiences among refugee women. This article highlights how this model benefits the peer research assistant and promotes community engagement among women.Item Resettlement, employment, and mental health among Syrian refugee men in Canada: An intersectional study using photovoice(International Journal of Environmental Research and Public Health, 2024) Clark, Nancy; Yurdakul, Gökce; Hilario, Carla; Elgharbawy, Heba; Izzden, Nedal; Moses, Elias; Zaidalkilani, MunaContext: The impact of forced migration on the mental health of refugee men is far-reaching and compounded by gendered masculinity, which shapes men’s access to employment and other resources. A gap in knowledge exists on the broader determinants of refugee men’s mental health. Methodology: Using community-based participatory action research and the arts-based method of photovoice, this study advances knowledge about the gendered impacts of forced migration from the perspective of (n = 11) Syrian refugee men in the Canadian context. Theoretical approaches of intersectionality and masculinity were applied to understand how power relations shape Syrian men’s identities, their access to employment, and impacts on their mental health. Analysis and Results: Syrian men’s identities were marginalized by working in low-wage jobs because of inequitable policies that favored Canadian experience and credentialing assessment processes that devalued their knowledge. Multiple and overlapping factors shaped Syrian men’s mental health including language and literacy barriers, time and stage of life, isolation and loneliness, belonging and identity, and gender-based stress. Caring masculinities performed through fathering, cultural connection, and service-based work promoted agency, hope, and resilience. Conclusions: Public health and community-based pathways must adopt gender-responsive and intersectional approaches to policy and practice. Peer-based programs may mitigate harmful forms of masculinity and promote transformative change to support refugee men’s mental health.Item Factors associated with Afghan household food security pre- and post-Taliban regime(Journal of Public Health Policy, 2023) Sadat, Seyyed Amin Allah; Pakravan-Charvadeh, Mohammad Reza; Gholamrezai, Saeed; Rahimian, Mehdi; Lane, Ginny; Béland, Daniel; Koc, Mustafa; Clark, Nancy; Omidvar, Nasrin; Sadeghi, Rasoul; Vatanparast, HassanTo determine multifaceted determinants of household vulnerability to food insecurity in Afghanistan before and after the Taliban takeover, we randomly selected 555 households from 13 provinces, conducted in-person surveys, and applied the Household Food Insecurity Assess Scale (HFIAS) and Structural Equation Modeling (SEM). We collected data from January to April 2022. We observed an increase in both prevalence and severity of food insecurity among Afghan households after the Taliban takeover. Approximately, 98% and 70% of interviewed households were food insecure after and before the Taliban takeover, respectively. Similarly, households were more likely to be severely food insecure (81%) than before (40%). Our results showed that policy and political conditions contributed substantially to the food insecurity of Afghan households after the Taliban takeover. We recommend that the Taliban forces facilitate the presence of humanitarian organizations and NGOs to improve low-income households' food security, especially for women and children. We also recommend that international organizations enhance their attempts to negotiate with the Taliban to ensure freedom for women.Item Why collect and use race/ethnicity data? A qualitative case study on the perspectives of mental health providers and patients during COVID-19(International Journal of Environmental Research and Public Health, 2024) Clark, Nancy; Quan, Cindy; Elgharbawy, Heba; David, Anita; Li, Michael; Mah, Christopher; Murphy, Jill; Costigan, Catherine L.; Ganesan, Soma; Guzder, JaswantContext: Calls to collect patients’ race/ethnicity (RE) data as a measure to promote equitable health care among vulnerable patient groups are increasing. The COVID-19 pandemic has highlighted how a public health crisis disproportionately affects racialized patient groups. However, less is known about the uptake of RE data collection in the context of mental health care services. Methodology: A qualitative case study used surveys with mental health patients (n = 47) and providers (n = 12), a retrospective chart review, and a focus group to explore healthcare providers’ and patients’ perspectives on collecting RE data in Canada. Results: The patient survey data and focus groups show that patients avoid providing identifying information due to perceived stigma and discrimination and a lack of trust. Providers did not feel comfortable asking patients about RE, leading to chart review data where RE information was not systematically collected. Conclusions: The uptake and implementation of RE data collection in mental health care contexts require increased training and support, systematic implementation, and further evaluation and measurement of how the collection of RE data will be used to mitigate systemic racism and improve mental health outcomes.