Introduction: Academic writing is a core element of a successful graduate program, especially at the doctoral level. Graduate students are expected to write in a scholarly manner for their thesis and scholarly publications. However, in some cases, limited or no specific training on academic writing is provided to them to do this effectively. As a result, many graduate students, especially those having English as an Additional Language (EAL), face significant challenges in scholarly writing. Further, faculty supervisors often feel burdened by reviewing and editing multiple drafts and find it difficult to help and support EAL students in the process of scientific writing. In this study, we explored academic writing challenges faced by EAL doctoral students and faculty supervisors at a research intensive post-secondary university in Canada.Methods and Analysis: We conducted a sequential explanatory mixed-method study using an online survey and subsequent focus group discussions with EAL doctoral students (n = 114) and faculty supervisors (n = 31). A cross-sectional online survey was designed and disseminated to the potential study participants using internal communications systems of the university. The survey was designed using a digital software called Qualtrics™. Following the survey, four focus group discussions (FGDs) were held, two each with two groups of our participants with an aim to achieve data saturation. The FGD guide was informed by the preliminary findings of the survey data. Quantitative data was analyzed using Statistical Package of Social Sciences (SPSS) and qualitative data was managed and analyzed using NVivo.Discussion: The study findings suggest that academic writing should be integrated into the formal training of doctoral graduate students from the beginning of the program. Both students and faculty members shared that discipline-specific training is required to ensure success in academic writing, which can be provided in the form of a formal course specifically designed for doctoral students wherein discipline-specific support is provided from faculty supervisors and editing support is provided from English language experts.Ethics and Dissemination: The general research ethics board of the university approved the study (#6024751). The findings are disseminated with relevant stakeholders at the university and beyond using scientific presentations and publications.
1 September 2018 in Patient Preference and Adherence
Purpose: The evidence is emerging that prescription medications are the topmost drivers of increasing health care costs in Canada. The financial burden of medications may lead individuals to adopt various rationing or restrictive behaviors, such as cost-related nonadherence (CRNA) to medications. Therefore, the purpose of this study is to provide an overview of the type, extent, and quantity of research available on CRNA to prescription drugs in Canada, and evaluate existing gaps in the literature. Methods: The study was conducted using a scoping review methodology. Six databases were searched from inception till June 2017. Articles were considered for inclusion if they focused on extent, determinants, and consequences of CRNA to prescription medication use in the Canadian context. Variables extracted for data charting included author(s), year of publication, study design, the focus of the article, sample size, population characteristics, and key outcomes or results. Results: This review found 37 studies that offered evidence on the extent, determinants, and consequences of CRNA to prescription medications in Canada. Depending on the population characteristics and province, the prevalence of CRNA varies between 4% and 36% in Canada. Canadians who are young (between 18 and 64 years), without drug insurance, have lower income or precarious or irregular employment, and high out-of-pocket expenditure on drugs are most likely to face CRNA to their prescriptions. The evidence that CRNA has negative health and social outcomes for patients is insufficient. Literature regarding the influence of prescribing health care professionals on patients’ decisions to stop taking medications is limited. There is also a dearth of literature that explores patients’ decisions and strategies to manage their prescription cost burden. Conclusion: More evidence is required to make a strong case for national Pharmacare which can ensure universal, timely, and burden-free access to prescription medications for all Canadians.
1 March 2019 in Topics in Spinal Cord Injury Rehabilitation
Background: Various injury characteristics such as cause, level, severity, and time since injury divide individuals with spinal cord injury (SCI) into many subgroups. The heterogeneity among individuals' injuries and personal characteristics has significant implications for SCI rehabilitation practice, specifically directed toward community reintegration, which is a key goal of rehabilitation interventions for people with disabilities. Purpose: This study aims to summarize the evidence on attributes that make the SCI population heterogeneous, the impact of these attributes on community reintegration, and the implications of heterogeneity for rehabilitation interventions directed toward optimizing community reintegration. Methods: We used an integrative review approach to conduct this study. MEDLINE, PubMed, CINAHL, EMBASE, Google Scholar, and PsycINFO were searched from inception until May 2017. Out of 670 articles retrieved, 49 provided evidence on the impact of various attributes that make SCI heterogeneous on rehabilitation outcomes related to community reintegration. Results: An array of injury-related, personal, social, and environmental factors are associated with various rehabilitation outcomes that affect community reintegration of people with SCI. There is level 1 evidence that social support, self-efficacy, and self-esteem facilitate community reintegration among people with SCI while there is level 5 evidence that presence of psychological or medical complications decreases it. There is lack of clarity on the impact of injury-related factors on community reintegration. Conclusion: This integrative review found that social support and individuals' self-efficacy can improve community reintegration of people with SCI. However, evidence regarding the impact of injury characteristics on community reintegration is still underdeveloped. Approaches directed at community reintegration should involve components of psychosocial, physical, and vocational rehabilitation while considering personal and societal aspects of an individual's life.
Background: Many individuals with disabilities face barriers to meaningful employment. Legislation has been put in place to ensure employment equity for individuals with disabilities in Canada. However, little is known about the employment profile and experiences of people with seeing disabilities. Objectives: The objectives of our research study were to explore the employment rates of people with seeing disabilities in Canada, the factors associated with being employed, and supports and barriers that affect their work participation. Methods: We used the nationally representative data from the Canadian Survey on Disability (CSD) 2017, collected by Statistics Canada. The CSD is a national cross-sectional survey of Canadians 15 years of age and above who face a functional limitation due to a health-related condition, representing more than 6 million (n = 6,246,640) Canadians. Our analyses focused on people who reported having a seeing disability. A subset of the complete dataset was created, focusing on individuals with a seeing disability. Weighted descriptive analyses were performed using SPSS. Multivariate logistic regression analyses were conducted for individuals between 25–64 years of age to identify predictors of employment. Results: Out of the estimated 892,220 working-age adults (25–64 years) with a seeing disability who were represented by the survey, 54% were employed, 6% were unemployed and 40% were not in the labour force. Early onset of seeing disability (OR: 1.33; 95% CI: 1.32–1.35), less severe seeing disability (OR: 1.51; 95% CI: 1.49–1.53), education above high school (OR: 2.00; 95% CI: 1.97–2.02) and daily use of the internet (OR: 2.46; 95% CI: 2.41–2.51) were positively related with employment. The top three employment accommodations that were needed and were made available included: modified work hours (45%); work from home (38.5%) and a modified workstation (37%). The top three needed but least available accommodations were technical aids (14%), communication aids (22%) and a computer with specialized software or adaptation (27%). Overall, 26% reported that an accommodation was required but was not made available by the employer. While 75% of individuals with a seeing disability were out of the labour force due to their condition, the remaining identified barriers that prevented them from working which included (top 3): (i) too few jobs available (20%); (ii) inadequate training/experience (19%), (iii) past attempts at finding employment were unsuccessful (19%). Conclusion: Adults with seeing disability in Canada experience lower labour force participation than the general population. Rigorous programs are required to assist them with the job search, job retraining and workplace accommodations. It is important for governments to improve efforts towards inclusive education and develop strategies that promote digital literacy of employees and job seekers with visual impairments. Although accessibility legislations have been put in place, programs should be established that provide accessibility solutions for various employers, enabling them to hire individuals with different abilities.
Purpose: The objectives of this study were to determine the effects of hearing disability on employment rates; examine how various factors are associated with employment; and identify workplace accommodations available to persons with hearing disabilities in Canada. Material and methods: A population-based analysis was done using the data collected through the 2017 Canadian Survey on Disability (CSD), representing 6 million (n = 6 246 640) Canadians. A subset of the complete dataset was created focusing on individuals with a hearing disability (n = 1 334 520). Weighted descriptive and multivariate logistic regression analyses were performed. Results: In 2017, the employment rates for working-age adults with a hearing disability were 55%. Excellent general health status (OR: 3.37; 95% CI: 2.29–4.96) and daily use of the internet (OR: 2.70; 95% CI: 1.78–4.10) had the highest positive effect on the employment rates. The top three needed but least available accommodations were communication aids (16%), technical aids (19%), and accessible parking/elevator (21%). Conclusion: Employment rates for persons with a hearing disability are lower than the general population in Canada. Employment outcomes are closely associated with one’s general health and digital skills. Lack of certain workplace accommodations may disadvantage individuals with a hearing disability in their employment.
Despite the abundant literature on the burden of rising costs of prescription medications, there is limited research to explore how these costs affect people and the decisions they are forced to make within the context of disability. In this qualitative study we explored strategies adopted, factors influencing, and the impact of some of these strategies to manage the burden of medication cost among persons with disabilities. We interviewed 12 adults with spinal cord injuries living in Canada, using a general inductive approach to analyze the data. We found that before cutting back on medications due to costs, participants generally tried and sought help from the government, employers, and/or their prescribers to improve their drug coverage. The key factors that participants considered while making decisions on the strategies included the cost and perceived importance of medications, their financial status, other competing needs, and their relationship with the prescribers. While some of their efforts were successful, many participants were still not able to obtain their medications as prescribed. In those cases, patients resorted to rationing strategies such as cutting back on medications, other essential needs, or selling assets. These strategies had serious implications on their health, healthcare utilization, and quality of life.