Exploring variations in the implementation of a health system level policy intervention to improve maternal and child health outcomes in resource limited settings: A qualitative multiple case study from Uganda.

Background: Despite growing literature, few studies have explored the implementation of policy interventions to reduce maternal and perinatal mortality in low- and middle-income countries (LMICs). Even fewer studies explicitly articulate the theoretical approaches used to understand contextual influences on policy implementation. This under-use of theory may account for the limited understanding of the variations in implementation processes and outcomes.

An innovative gamification tool to enhance intercultural competence and self-efficacy among healthcare professionals caring for vulnerable migrants and refugees.

Background: The growing number of vulnerable migrants and refugees (VMRs) in the European Union presents challenges to healthcare systems, emphasizing the need for enhanced intercultural competence training for healthcare professionals. Educational escape rooms, using gamification-based principles, may offer an innovative solution to improve these competencies.

Objective: This pilot study evaluates the acceptability and preliminary effectiveness of an educational escape room aimed at improving intercultural competence, self-efficacy, and knowledge among healthcare students and professionals caring for VMRs.

Navigating the burden of proof and responsibility: A narrative inquiry into Indigenous medical learners' experiences.

Introduction: Many medical schools have well-established admission pathways and programming to support Indigenous medical workforce development. Ideally, these efforts should contribute to attracting highly qualified Indigenous applicants which, in turn, may improve accessible, quality care for Indigenous people. However, it is difficult to evolve and tailor these approaches without a situated understanding of Indigenous learners' experiences.

Shapeshifters, systems thinking and settler colonial logic: Expanding the framework of analysis of Indigenous health equity.

Despite increased attention in the health care field to the disparate health outcomes of Indigenous peoples, inequities persist. Analytical frameworks with the capacity to account for integrated systems analysis of power and domination are underrepresented yet vital to affecting change. Narratives represent Indigenous approaches to systems thinking, yet are often excluded from the literature on theorizing health systems.

The prevalence of distress, depression, anxiety, and substance use issues among Indigenous post-secondary students in Canada.

This study aimed to estimate the prevalence of mental illness and substance use among Indigenous students attending Canadian post-secondary institutions. We obtained data from the National College Health Assessment - American College Health Association Spring 2013 survey, which includes 34,039 participants in 32 post-secondary institutions across Canada. We calculated prevalence estimates with 95% confidence intervals (CI).

Reframing resilience: Strengthening continuity of patient care to improve the mental health of immigrants and refugees.

Refugee and immigrant populations experience many pre- and post-migration risk factors and stressors that can negatively impact their mental health. This qualitative study aimed to explore the system-level issues that affect the access to, as well as quality and outcomes of mental health care for immigrants and refugees, with a particular focus on challenges in the continuity of patient care. A multidisciplinary group of health providers, including nurses, identified six themes including (i) perceived access to care; (ii) coordination amongst health care providers; (iii) patient connections with community organizations; (iv) coordinated care planning; (v) organizational protocols, policies and procedures and (vi) systemic and health care training needs.

Assessing trauma in a transcultural context: challenges in mental health care with immigrants and refugees.

The growing numbers of refugees and immigrants from conflict-prone areas settling throughout the world bring several challenges for those working in the mental health care system. Immigrants and refugees of all ages arrive with complex and nuanced mental health histories of war, torture, and strenuous migration journeys. Many of the challenges of addressing the health care needs for this growing population of immigrants and refugees are often unfamiliar, and thus practices to address these challenges are not yet routine for care providers and health care organizations.

Insiders' Insight: Discrimination against Indigenous Peoples through the Eyes of Health Care Professionals.

Discrimination in the health care system has a direct negative impact on health and wellbeing. Experiences of discrimination are considered a root cause for the health inequalities that exist among Indigenous peoples. Experiences of discrimination are commonplace, with patients noting abusive treatment, stereotyping, and a lack of quality in the care provided, which discourage Indigenous people from accessing care.

Lost in Maps: Regionalization and Indigenous Health Services.

The settlement of the land now known as Canada meant the erasure - sometimes from ignorance, often purposeful - of Indigenous place-names, and understandings of territory and associated obligations. The Canadian map with its three territories and ten provinces, electoral boundaries and districts, reflects boundaries that continue to fragment Indigenous nations and traditional lands. Each fragment adds institutional requirements and organizational complexities that Indigenous nations must engage with when attempting to realize the benefits taken for granted under the Canadian social contract.