Wellesley Institute

About: Wellesley Institute is a nonprofit organization based out in Toronto, Ontario, Canada. It is known for research contribution in the topics: Mental health & Refugee. The organization has 37 authors who have published 46 publications receiving 1371 citations.

Ethical dilemmas in community-based participatory research: recommendations for institutional review boards.

Abstract: National and international codes of research conduct have been established in most industrialized nations to ensure greater adherence to ethical research practices. Despite these safeguards, however, traditional research approaches often continue to stigmatize marginalized and vulnerable communities. Community-based participatory research (CBPR) has evolved as an effective new research paradigm that attempts to make research a more inclusive and democratic process by fostering the development of partnerships between communities and academics to address community-relevant research priorities. As such, it attempts to redress ethical concerns that have emerged out of more traditional paradigms. Nevertheless, new and emerging ethical dilemmas are commonly associated with CBPR and are rarely addressed in traditional ethical reviews. We conducted a content analysis of forms and guidelines commonly used by institutional review boards (IRBs) in the USA and research ethics boards (REBs) in Canada. Our intent was to see if the forms used by boards reflected common CBPR experience. We drew our sample from affiliated members of the US-based Association of Schools of Public Health and from Canadian universities that offered graduate public health training. This convenience sample (n = 30) was garnered from programs where application forms were available online for download between July and August, 2004. Results show that ethical review forms and guidelines overwhelmingly operate within a biomedical framework that rarely takes into account common CBPR experience. They are primarily focused on the principle of assessing risk to individuals and not to communities and continue to perpetuate the notion that the domain of “knowledge production” is the sole right of academic researchers. Consequently, IRBs and REBs may be unintentionally placing communities at risk by continuing to use procedures inappropriate or unsuitable for CBPR. IRB/REB procedures require a new framework more suitable for CBPR, and we propose alternative questions and procedures that may be utilized when assessing the ethical appropriateness of CBPR.

Management of common musculoskeletal problems: A survey of Ontario primary care physicians

Abstract: BACKGROUND: In Canada, primary care physicians manage most musculoskeletal problems. However, their training in this area is limited, and some aspects of management may be suboptimal. This study was conducted to examine primary care physicians9 management of 3 common musculoskeletal problems, ascertain the determinants of management and compare management with that recommended by a current practice panel. METHODS: A stratified computer-generated random sample of 798 Ontario members of the College of Family Physicians of Canada received a self-administered questionnaire by mail. Respondents selected various items in the management of 3 hypothetical patients: a 77-year-old woman with a shoulder problem, a 64-year-old man with osteoarthritis of the knee and a 30-year-old man with an acutely hot, swollen knee. Scores reflecting the proportion of recommended investigations, interventions and referrals selected for each scenario were calculated and examined for their association with physician and practice characteristics and physician attitudes. RESULTS: The response rate was 68.3% (529/775 eligible physicians). For the shoulder problem, all of the recommended items were chosen by the majority of respondents. However, of the items not recommended, ordering blood tests was selected by almost half (242 [45.7%]) as was prescribing an NSAID (236 [44.7%]). For the knee osteoarthritis the majority of respondents chose the recommended items except exercise (selected by only 175 [33.1%]). Of the items not recommended, tests were chosen by about half of the respondents and inappropriate referrals (chiefly for orthopedic surgery) were chosen by a quarter. For the acutely hot knee, the majority of physicians chose all of the recommended items except use of ice or heat (selected by only 188 [35.6%]). Although most (415 [78.5%]) of the respondents selected the recommended joint aspiration for this scenario, 84 (15.9%) omitted this investigation or referral to a specialist. The selection of recommended items was strongly associated with training in musculoskeletal specialties during medical school and residency. INTERPRETATION: Primary care physicians9 management of 3 common musculoskeletal problems was for the most part in accord with panel recommendations. However, the unnecessary use of diagnostic tests, inappropriate prescribing of NSAIDs, low use of patient-centred options such as exercise, and lack of diagnostic suspicion of infectious arthritis are cause for concern. The results point to the need for increased exposure to musculoskeletal problems during undergraduate and residency training and in continuing medical education.

Determinants of physician confidence in the primary care management of musculoskeletal disorders.

Abstract: Objective. To examine the determinants of confidence in managing musculoskeletal (MSK) disorders among primary care physicians. Methods. A self-administered questionnaire was mailed to a stratified (by urban/rural location) random sample of 798 Ontario primary care physicians who were members of the College of Family Physicians of Canada. Two mailings and a reminder postcard were used to increase response. As the main outcome measure, confidence was measured on a 10 point Likert-type scale. Results. The overall response rate was 68.3%. Most respondents were practising in a full time group setting ; their average age was 40.3 years. Respondents were significantly more confident in performing a comprehensive cardiovascular examination than a MSK examination. Highest levels of confidence were observed for using nonsteroidal antiinflammatory drugs and managing common MSK disorders. Lower scores were reported for doing a joint injection/aspiration. Rural physicians were more confident than urban physicians in doing a joint injection/aspiration and monitoring patients who were taking disease modifying agents. Previous continuing medical education (CME) was significantly (p < 0.01) related to all confidence outcomes using multiple regression analysis. For many outcomes, men reported higher confidence scores than women after adjustment for various demographic characteristics. Conclusion. CME may be the most important and modifiable variable to improve physician management of MSK disorders.

Governing through community allegiance: a qualitative examination of peer research in community-based participatory research

Abstract: The disappointing results of many public health interventions have been attributed in part to the lack of meaningful community engagement in the planning, implementation, and evaluation of these initiatives Community-based participatory research (CBPR) has emerged as an alternative research paradigm that directly involves community members in all aspects of the research process Their involvement is often said to be an empowering experience that builds capacity In this paper, we interrogate these assumptions, drawing on interview data from a qualitative study investigating the experiences of 18 peer researchers (PRs) recruited from nine CBPR studies in Toronto, Canada These individuals brought to their respective projects experience of homelessness, living with HIV, being an immigrant or refugee, identifying as transgender, and of having a mental illness The reflections of PRs are compared to those of other research team members collected in separate focus groups Findings from these interviews are discussed with an attention to Foucault's concept of ‘governmentality’, and compared against popular community-based research principles developed by Israel and colleagues While PRs spoke about participating in CBPR initiatives to share their experience and improve conditions for their communities, these emancipatory goals were often subsumed within corporatist research environments that limited participation Overall, this study offers a much-needed theoretical engagement with this popular research approach and raises critical questions about the limits of community engagement in collaborative public health research