How data gaps affect Canadians and researchers alike

Addressing the data deficits that hold back health care systems

How data gaps affect Canadians and researchers alike

A Globe and Mail article published late January revealed the difficulties of obtaining data in fields such as public health and energy economics.

‘Data gaps’ are the “areas at the national level in which data [is] not collected or readily accessible.” This includes inconsistent data collection, which makes it difficult to compare data, and data that is not updated on a regular basis.

For example, the article reports that data gaps have impeded research in a study on whether the American rise in “deaths of despair” — deaths of the white, middle-aged working class — can be observed in Canada as well.

One reason for data deficits lies in the appropriate collection of data. And even if data has been collected appropriately, barriers to accessing the data may remain.

Associate Professor Arjumand Siddiqi from the Dalla Lana School of Public Health explained in an email to The Varsity that, in her experience, data gaps occur in “groups for which we do not make a concerted effort to sample or identify.”

A summary on the evaluation of the Health Statistics Program between 2011 and 2015 highlighted that one of the recommendations made in the evaluation was regarding management.

The summary explained that for health statistics, which includes births, deaths, stillbirths, divorces, and marriages, the information would now be published 10–11 months after the reference period ended.

A recent blog post by Statistics Canada said that more, specific information on the population was needed to resolve the issue of data gaps.

Siddiqi suggested that statistics may be difficult to obtain as the “infrastructure or the mechanisms” regarding availability and accessibility of the information have not been facilitated by statistical agencies like Statistics Canada. For example, Statistics Canada’s Research Data Centres inhibit collaboration between researchers who are not near the centres in which the data they require is stored.

Data in the field of Siddiqi’s research, which is centred on the relationship between social and economic factors and health, are difficult to obtain.

Other areas in which researchers experience difficulty in studying health are racial inequalities.

“Existing surveys don’t have sufficient sample sizes of non-whites, nor are these samples representative of those populations,” said Siddiqi.

While one tool, like the census, would provide information on Canadians, there lacks a relationship between other sources for the collected data to be useful.

It is important for Canadians to know our statistics as “we need to know what’s happening in our society, who is benefitting, and whom we are failing,” said Siddiqi.

Moving toward trans-inclusive healthcare in Canada

U of T researchers advocate for affirming and personalized health care practice for LGBTQ+ individuals

Moving toward trans-inclusive healthcare in Canada

Canada’s transgender population continues to face challenges from transphobia and discrimination, which, among other factors, influences their health and development.

Recent efforts by the Canadian government and affiliated agencies address issues that LGBTQ+ communities face.

In 2016, the Canadian federal government passed Bill C-16, which amended the Canadian Human Rights Act to include gender identity and expression as one of the prohibited grounds of discrimination.

In the health care setting, LGBTQ+ individuals face multiple barriers that contribute to the disparities in the management and care of these individuals.

Alex Abramovich, Assistant Professor at the Dalla Lana School of Public Health and Independent Scientist at the Centre for Addiction and Mental Health (CAMH), has been studying the health care needs of LGBTQ+ youth for more than a decade.

From his experience working with young trans people, Abramovich wrote to The Varsity that this population has an unmet need for mental and physical care.

Many transgender individuals are “unable to come out and speak honestly about their identity and healthcare needs because they may not know whether or not it will be safe to do so,” wrote Abramovich, explaining how gender identity affects access to health care.

He added that some trans youth do not even have a family physician due to “previous experiences where their gender identity and sexual orientation were pathologized.”

To address the urgency for improved health care accessibility by trans populations, Abramovich recently co-authored an article in the Canadian Medical Association Journal (CMAJ) that provides comprehensive steps for physicians to follow to become more trans-inclusive and trans-competent.

One of the recommendations listed in the article was to privately ask all patients what name and pronoun they go by, instead of making assumptions based on perceptions of their voice, appearance, or name and sex listed on their health card.

Another key recommendation made in the article was to ensure that patients are addressed with a gender-affirming approach that does not view gender variance as pathological.

“These are just some of the things that health care professionals can implement immediately,” wrote Abramovich, expanding on the purpose of publishing such health care recommendations.

Staff Physician and Adolescent Medicine Specialist at St. Michael’s Hospital, Joey Bonifacio, argues in a review article recently published in CMAJ that adolescents’ mental health improves when they receive gender-affirming care.

Bonifacio mentions that primary care providers are equipped with some published medical guidelines on providing care for the transgender population. However, practice is hampered by a lack of experience and training in trans health issues.

He suggests that primary care providers support trans adolescents with gender dysphoria by facilitating discussions about the “timing of social transitioning, reviewing and overseeing the potential use of medical management, and connecting them with local community resources and supports.”

Besides improving the management and care of trans individuals, U of T-affiliated researchers suggest that routine data collection can “contribute to evolving norms in Canadian society regarding sexual orientation and gender identity.”

Currently, there is a lack of national and territorial data on trans populations, mainly because there is no standardized way of collecting and analyzing data about gender identity.

Andrew Pinto, Assistant Professor in the Department of Family and Community Medicine at U of T and Staff Physician at St. Michael’s Hospital, tackled this challenge with his research group by examining how Canadian patients react to being asked routinely about sexual orientation and gender identity.

By administering a sociodemographic survey of all patients in the waiting rooms of St. Michael’s Hospital on a regular basis and later conducting semi-structured interviews with 27 patients, Pinto and his research group found that the majority of patients appreciated the variety of options available for both the sexual orientation and gender identity questions.

However, some patients felt discomfort in answering such questions, and some felt that their identities were not reflected in the options despite efforts to provide diversity in survey responses.

Based on these research findings, the authors suggest that an open-ended option such as Identity not listed (please specify) could be included in addition to prespecified options. They also suggest that health care organizations should set the stage for asking these questions by explaining how the data will be used and ensuring that clinics are LGBTQ+-positive spaces.

Pinto and his colleagues hope that further research will be done in a variety of Canadian and international settings in consultation with LGBTQ+ communities, as such data can help organizations identify health inequities and build a framework with improved and inclusive care.

It’s time to get moving

Two U of T profs set to launch study on regulated movement breaks in undergraduate classes

It’s time to get moving

Professors Ananya Banerjee and Jackie Bender decided in January 2015 that they were going to add something new to their three-hour lectures: for three minutes, they integrated everything from dance routines to stretching just to get their graduate students to move.

These regulated movement breaks received very positive responses from students. Now, the professors are hoping to take this feedback to the next level and study its effects on students and instructors in the undergraduate setting.

The idea of regulated movement breaks all started with a paper released in 2015 by U of T researchers from the Institute of Health Policy, Management, and Evaluation. “[This study] showed that individuals who are sedentary throughout their day, even though they are exercising regularly, have higher risk for various chronic diseases,” said Banerjee, a Registered Kinesiologist and professor at the Dalla Lana School of Public Health.

Upon reading this paper, Banerjee and Bender decided to integrate regulated movement breaks into their classes. “I’m trained to create exercise programs in different settings, and given that Dr. Bender and I… were teaching our graduate course that year… we decided that we really [needed] to implement movement breaks into the classroom to reduce sedentary behaviour among students,” Banerjee explained.

There’s a lot of science fueling support for fitness breaks in the classroom. “A number of studies have shown that movement breaks increase the levels of interactivity with other students and with the course instructor, and that this positively influences acts of collaborative learning, which also helps to improve student learning retention,” said Bender, also a professor at the Dalla Lana School of Public Health.

While introducing these fitness breaks in the graduate setting, the professors conducted a quality improvement survey. “Movement breaks were met with high rates of acceptability from students, with about 86 per cent of students reporting that they enjoyed these short bouts of movement,” said Bender.

Participants also noted that the breaks helped improve their engagement with other students and instructors. Other impacts extended beyond the classroom and increased students’ intention to be more active and less sedentary outside of class.

With a successful application to the Learning and Education Advancement Fund granted by the Provost’s Office at U of T, Banerjee and Bender are now launching a more extensive study in the undergraduate setting.

For the 2017–2018 academic year, they are planning to integrate and assess movement breaks across all three campuses and involve over 1,000 students from various faculties.

“We are conducting a quasi experimental pre-post design [with] certain classes being exposed to intermission and other classes not… and then we’re going to be looking at the impact of participating in these structured, three minute movement breaks, that are led by… videos of certified instructors,” explained Bender.

These videos, which will be streamed by lecturers in their 2–3 hour sessions, will range from mindfulness to Zumba and everything in between. While the focus of this study is on students, the professors will also be tracking feedback from instructors, who will also participate in these exercises throughout the year.

They hope to get more insight on the impact of fitness breaks on student and instructor engagement, student well-being, as well as physical activity and sedentary behaviours.

For both professors, it all comes down to helping students. “We [really just] expect that through these movement breaks, they’ll lead to more engaged students who will feel better, learn better, and develop positive relationships with instructors and other students,” said Bender.