Item“Stepping up to the plate”: Identifying cultural competencies when providing health care to Canada’s military and Veteran families(University of Toronto Press, 2019-09-01) Tam-Seto, Linna; Krupa, Terry; Stuart, Heather; Lingley-Pottie, Patricia; Aiken, Alice B.; Cramm, HeidiMilitary family life is characterized by frequent relocations, regular periods of separation, and living with the persistent risk of injury or death of their military family member. The cumulative effects of these life events impact the health and wellness of military and Veteran families (MVFs) and may be exacerbated by challenges of accessing and navigating new health care systems when families relocate or when confronted with health care providers (HCPs) unaware of their experiences. Developing cultural competency in HCPs has been found to be beneficial to both the service provider and the ser vice user. The purpose of this study is to identif y cultural competencies for HCPs who work with MVFs. Methods: We completed a qualitative study using critical incident one-on-one inter views with HCPs. We used framework analysis for data analysis. Results: In total, we completed nine inter views with HCPs who have experience working with MVFs. Cultural competencies were identified in the domains of cultural awareness, cultural sensitivity, cultural knowledge, and cultural skills. Evidence also indicates the role of the ecological context on the ability of HCPs to be culturally competent. Discussion: Necessary competencies have been identified when providing culturally competent care to MVFs. The results highlight the need for MVF cultural competency training during pre-service health professional curricula and continuing education. We have acknowledged the need for policy and regulatory changes to facilitate the access and utilization of culturally informed health care. Finally, the cultural competencies identified will contribute to the development of an MVF cultural competency model for HCPs working in Canada. ItemDevelopment and validation of a case-finding algorithm for neck and back pain in the Canadian Armed Forces using health administrative data(University of Toronto Press, 2019-09-01) Theriault, Francois L.; Lu, Diane; Hawes, Robert A.In military organizations, neck and back pain are a leading cause of clinical encounters, medical evacuations out of theatres of operations, and involuntary release from service. However, tools to efficiently and accurately study these conditions in Canadian Armed Forces (CAF) personnel are lacking, and little is known about their distribution across the Canadian military. Methods: We reviewed the medical charts of 691 randomly sampled CAF personnel, and determined whether these subjects had suffered from neck or back pain at any point during the 2016 calendar year. We then developed an algorithm to identify neck or back pain patients, using large clinical and administrative databases. The algorithm was then validated by comparing its output to the results of our medical chart review. Results: Of the 691 randomly sampled subjects, 190 (27%) had experienced neck or back pain at some point during the 2016 calendar year, 43% of whom had experienced chronic pain (i.e. pain lasting for at least 90 consecutive days). Our final algorithm correctly identified 65% of all patients with past-year pain, and 80% of patients with past-year chronic pain. Overall, the algorithm’s measures of diagnostic accuracy were as follows: 65% sensitivity, 97% specificity, 91% positive predictive value, and 88% negative predictive value. Discussion: We have developed an algorithm that can be used to identify neck and back pain in CAF personnel efficiently. This algorithm is a novel research and surveillance tool that could be used to provide the epidemiological data needed to guide future intervention and prevention efforts. ItemPrevalence of Musculoskeletal Disorders Among Canadian Firefighters: A Systematic Review and Meta-Analysis(2020-05-09) Nazari, Goris; MacDermid, Joy; Cramm, HeidiFirefighters are set to respond to a number of dynamic demands within their roles that extend well beyond fire suppression. These tasks (i.e., heavy lifting, awkward postures) and their unpredictable nature are likely contributing factors to musculoskeletal disorders (MSDs). Several individual studies have assessed the prevalence of MSDs among Canadian firefighters. Therefore, a systematic review and meta-analysis was conducted to critically appraise the quality of the body of available literature and to provide pooled point- and period-prevalence estimates of anatomical regions of MSDs among Canadian firefighters. Methods: The MEDLINE, Embase, PubMed and Web of Science databases were searched from inception to November 2018. Cross-sectional cohort studies with musculoskeletal prevalence estimates (point- and period-) of career/professional firefighters in Canada were identified and critically appraised. MSDs were defined as sprains/strains, fractures/dislocations and self-reported bodily pain (chronic or acute). Period- and point-prevalence estimates were calculated, and study-specific estimates were pooled using a random-effects model. Results: Five eligible cohort studies (3 prospective, 2 retrospective) were included, with a total of 4,143 firefighters. The participants had a mean age range of 34 (SD = 8.5) to 42.6 (SD = 9.7) years. The reported types of MSDs included sprain or strain, fractures, head, neck, shoulder, elbow, arm, hand, back, upper thigh, knee, and foot pain. The point-prevalence estimate of shoulder pain was 23.00% (3 studies, 312 of 1,491 firefighters, 95% CI, 15.00–33.00), back pain was 27.0% (3 studies, 367 of 1,491 firefighters, 95% CI, 18.00–38.00), and knee pain was 27.00% (2 studies, 180 of 684 firefighters, 95% CI, 11.00–48.00). The one-year period-prevalence estimate of all sprain/strain injuries (all body parts) was 10.0% (2 studies, 278 of 2,652 firefighters, 95% CI, 7.00–14.00). Discussion: High point-prevalence estimates (1 in 4 firefighters) of shoulder-, back-, and knee-related MSDs were identified among Canadian firefighters. This emphasizes the need for early assessment, intervention, and injury prevention strategies that reflect how units work together to maximize ergonomic efficiency and injury prevention. ItemInvestigating the Characteristics of Canadian Armed Forces Help-Seekers, Non-Help Seekers, and No Mental Health Need Groups: A Population-Based Analysis(2020-05-09) Wood, Valerie; Linden, Brooke; Tam-Seto, Linna; Stuart, HeatherThis secondary analysis compared three groups of Canadian Armed Forces (CAF) members in their demographics and attitudes toward mental health care: those with a need who have sought help (help-seekers), those with a need who have not sought help (non-help seekers) and those with no current need (no-need). Methods: Data from the 2013 Canadian Forces Mental Health Survey, which included responses from 6,996 Regular Force and 1,469 Reserve Force members, was used. Several variables were applied to classify members according to mental health need and help-seeking status. Results: The three groups had distinct demographic profiles. In addition, results from a discriminant function analysis indicated group differences in attitudes toward mental health care. Help-seekers reported more negative attitudes toward acquiring mental health care for reasons that relate to stigma and career implications, while non-help seekers reported more negative attitudes toward mental health care that reflect a distrust of professionals and preference for self-management. Discussion: These findings suggest more can be done to further support help-seekers who report stigma and to support non-help seekers who may have attitudinal barriers to traditional care but may benefit from innovative care solutions. ItemCorrelates of perceived military to civilian transition challenges among Canadian Armed Forces Veterans(2020-04-30) Lee, Jennifer E. C.; Dursun, Sanela; Skomorovsky, Alla; Thompson, JamesAnalyses of the Canadian Armed Forces Transition and Well-Being Survey (CAFTWS) were conducted to identify the most prominent challenges faced by Canadian Armed Forces (CAF) Veterans during their military to civilian transition, and to assess the importance of various characteristics, including release category and health status, as risk factors for experiencing such challenges. Methods: Prevalence estimates and logistic regression analyses were computed on data from the CAFTWS, which was administered in 2017 to 1,414 Regular Force Veterans released from the CAF in the previous year. Results: Two of seven perceived transition challenges had the strongest associations with difficult post-military adjustment: the loss of military identity (adjusted odds ratio [AOR] = 5.4) and financial preparedness (AOR = 2.3). In adjusted regression analyses, Veterans who had non-commissioned rank, who had primarily served in the army, had 10–19 years of service, had a medical release, and had poor physical or mental health, were more likely to report loss of military identity. Veterans who had junior non-commissioned rank, a medical release, and poor physical or mental health were more likely to report challenges with financial preparedness. Furthermore, we observed significant interaction effects between Veterans’ release type and their health status. Discussion: This study extends prior research to inform ongoing efforts to support the well-being of CAF members adjusting to post-service life. Findings emphasize the importance of preparing transitioning service members and civilian communities for the social identity challenges they may encounter. Findings also support the value of programs and services that help prepare transitioning service members with managing finances, finding education and employment, relocating, finding health care providers, and understanding benefits and services.