Davina Banner

Background: In Canada and across the world, populations in rural and remote settings are aging rapidly, have poorer health outcomes as compared to their urban counterparts, and experience more limited access to care. These disparities are worsened for Indigenous and racialized populations, and those facing social exclusions. Access to team-based primary care in rural, northern, and remote communities in Canada is recognized as an essential way to promote health and wellbeing. However, accessing care is shaped by social and healthcare structures, relationships, and local resources, and many people are required to wait long periods or travel long distances to access care. This review was co-led with two patient partners and sought to address the question ‘How do integrated primary care teams promote access to primary care for people residing in rural communities in Canada?’ Methods: A comprehensive scoping review of the literature was undertaken, guided by the principles of appreciative inquiry and cultural safety. A rigorous search of the peer-reviewed journal articles was undertaken, and studies were screened and appraised by two independent reviewers. A final cohort of 16 articles were captured and were analyzed thematically. This Scoping Review adhered to the PRISMA-ScR Checklist. Results: Thematic analysis identified three core themes 1) gaps in access to services; 2) innovative care models; and 3) continuity of care. It was noted that rural communities face limited access to healthcare with provider shortages, long wait times, and the need to travel for care. Analysis of the captured studies revealed that team-based care can address many of the gaps related to accessing care for rural and remote Canadians. In addition, supporting continuity of care for patients through diverse models of care that include patient priorities, cultural learnings, and diverse ways of communicating appear to confirm patients’ experiences with primary health care in rural and remote settings. Implications: This Scoping Review revealed that team-based care can address many of the gaps related to accessing care in rural and remote settings. While focused on Canada, the review is transferrable to other rural and remote settings and would be of interest to healthcare makers, policymakers, patients, and research engaged in the planning of integrated care services. In addition, supporting continuity of care for patients through diverse models of care that include patient priorities, cultural learnings, and diverse ways of communicating can enhance patient outcomes and begin to address complex health disparities and inequities.

Background: Healthcare organizations globally are challenged to develop and integrate services that better meet the needs of patients and communities. To help address this, there has been a growing transition towards more collaborative modes of research whereby patients and the public, along with other knowledge users, are actively engaged within teams to contribute to setting research priorities and translating outcomes into policy and practice. While efforts to support research co-production have gained significant traction, common criticisms are levied at the lack of diversity and inclusive in engagement. This risks further perpetuating existing health inequities and disparities. This research specifically explores methods and practices of equity-driven research co-production. Methods: In this presentation, we reflect upon the insights gathered from multiple Canadian patient-oriented and patient-partnered research studies exploring engagement in health research. Specifically, we reflect upon the experiences of populations with diverse experiences and perspectives, including older adults, immigrant, refugee, and newcomers, and those living with complex medical conditions, and identify methods, practices, and strategies that can be employed to support authentic and meaningful engagement in health research. Results: Barriers to engagement in health research can span complex physical, social, or economic factors, and be underpinned by specific needs related to their social location and resources. Here, we highlight examples from four patient-oriented studies, culminating in insights from over 200 participants from diverse populations. We offer actionable and practical strategies to foster authentic and safe engagement in research addressing integrated care. Implications: Rural and underserved populations commonly report multiple overlapping and intersecting barriers to research, resulting in more fewer opportunities to engage in research that can shape healthcare. We present actionable strategies to support patient and public engagement in integrated care research, highlighting steps to support diversity and inclusion. These findings have direct application for teams engaged in integrated care research, along with offering broader insights for those engaged in co-production activities in healthcare.

Working during an outbreak poses additional challenges for staff working in long-term care facilities (LTCFs). The existing literature explores the experiences of LTCF staff during the COVID-19 pandemic, but there is a paucity of research focusing on the specific challenges of working during COVID-19 outbreaks in rural and northern communities. Secondary analysis was conducted on interview transcripts from sixteen participants with experience working during COVID-19 outbreaks in northern LTCFs. Participants engaged in in-depth semi-structured interviews and shared their experiences working during COVID-19 outbreaks in the COVID-19 pandemic. Seven themes emerged through thematic analysis, including: (1) personal fear and moral distress, (2) coping with resident death due to COVID-19, (3) relationship dynamics, (4) changing workload expectations during staffing shortages, (5) resource constraints and organizational support gaps, (6) resources and support, and (7) impact of vaccinations. Findings emphasize the increased complexity of working during a COVID-19 outbreak in rural and northern communities and describe factors that shaped both the positives and negatives of the experience for staff. These findings show that rural and northern LTCFs faced additional challenges during COVID-19 outbreaks due to pre-existing resource and staffing shortages. However, we also highlight the unique strength of these communities in how they coped and supported each other through COVID-19 outbreaks. This study provides practical insights to inform improved outbreak management, including the need for region-specific guidance and support, clear communication from management, reliable access to personal protective equipment, consistent staffing, and support for grief and burnout, all while highlighting the voices of those who worked through these outbreaks.

Background: Artificial intelligence (AI) continues to emerge into nursing practice with much of the AI research being conducted in the acute care sector. Community health nurses (CHNs) have distinct skills and knowledge focusing on helping clients to live well in the community. Community practice is an essential part of healthcare yet often overlooked, creating a knowledge gap. This research aims to understand CHNs’ knowledge and perceptions of AI to inform future practice. Method: An explanatory sequential mixed methods design was conducted, a cross-sectional survey followed by focus groups to combine both sets of results for a comprehensive perspective. Results: There were 228 survey respondents and 27 participants forming 8 focus groups. The survey revealed professional concerns: AI giving a wrong recommendation (77.7%) or if a correct recommendation was dismissed (73.8%) with focus groups explaining they knew their responsibility in decision-making, their concerns focused on accepting AI recommendations blindly or using recommendations to assist with decision-making. Overall CHNs felt AI applications had usefulness (68.8%-88%), the focus groups further explained clinical relevance, user friendly and time efficiency were factors that would determine usefulness. Conclusions: Dedicated time for AI education for CHNs is needed to address how recommendations are generated and the significance to give to AI recommendations. Clear policies and guidelines need to be established to inform CHNs use of AI. Success of AI in CHNs practice is dependent on applications that do not add time to their busy schedules.

This study explored communication access and barriers from the perspectives of 96 hospital staff across Canada in February 2025. A cross-sectional observational design was used, with an online survey distributed through social media platforms. Statistical analyses, including binary logistic regression, were conducted using IBM SPSS Statistics version 29. Most respondents identified as female (89.0%) and were between 19 and 49 years old. One in ten hospital staff reported that patients always received communication support from staff, and fewer than 5.0% reported consistent access to communication devices. Support from communication professionals was limited, with 20.2% indicating that this support was never available. Environmental barriers included difficulty accessing devices independently (24.8%), lack of privacy (21.7%), poor Wi-Fi or cellular connectivity (17.2%), and noise (14.7%). When communicating with older adults, staff cited time constraints (53.0%), unclear explanations (13.0%), language barriers (13.0%), and emotional stress (7.0%) as key challenges. Hospital staff appeared committed to supporting patient communication; however, barriers such as limited time, staffing availability, access to communication devices, and environmental challenges may affect the consistency of this support. Communication training was associated with staff perceptions of communication needs and inequities among patients. These findings highlight perceived communication gaps and may support further assessment of communication resources, staff support, and organizational approaches to improving patient-centered communication in hospital settings.

Background: Hospitalization can disrupt patients’ communication and social connections, potentially contributing to social isolation, while the supportive role of family and friends in communication is often underrecognized. Objective: This study examines communication access barriers and their association with social isolation among hospitalized patients, based on reports from family and friends. Methods: A cross‐sectional online survey of family/friends across Canada ( N = 179) was conducted to examine patient communication and social isolation. The questionnaire was distributed via Facebook advertisements (Meta Ads Manager) and administered through SurveyMonkey (February 14–28, 2025). Descriptive and inferential analyses were conducted. Results: Most respondents (Family and Friends) were female (78.8%) and were aged 40–49 years. Respondents reported that in‐person communication was preferred (67.9%), and 58.5% shared communication responsibilities with patients and hospital staff. However, only 11.2% reported consistent staff communication support, and 5.9% reported reliable device access. Key barriers included lack of independent access to devices (23.5%), poor Wi‐Fi (17.5%), and privacy concerns (16.1%). Fewer believed that communication challenges were prioritized equally with physical care (19.1%). Communication gaps were associated with social isolation. Inadequate support increased reported social isolation (odds ratio [OR] = 4.03, 95% confidence interval [CI]: 1.83–8.85), and patients whose communication concerns were not prioritized had greater odds of feeling social isolation (OR = 3.49, 95% CI: 1.12–10.83). Conclusions: Based on family and friends’ reports, communication barriers in hospitals are common, despite patients having active social networks. Limited staff support, challenges with independent device use, and Wi‐Fi issues highlight modifiable gaps in hospital communication infrastructure.

Movement behaviour guidelines should be tailored to contextual factors influencing physical activity, sedentary behaviour, and sleep to support effective mobilization. Compared to urban areas, rural communities have distinct environmental characteristics and require context-specific strategies to promote healthy movement behaviours. This study aimed to evaluate awareness and knowledge of the Canadian 24-Hour Movement Guidelines for Adults (18-64 years) living in rural communities and explore how to adapt the Canadian 24-Hour Movement Guidelines Communications Toolkit for greater impact and relevance. We adopted an explanatory sequential mixed methods study design, in which adults living in rural communities of British Columbia, Canada, completed a cross-sectional survey (N = 76) followed by individual interviews (N = 12). Survey data were analysed for awareness and knowledge of Movement Guidelines using descriptive statistics and Chi-squared tests. Interview data were analyzed following a deductive thematic approach using the Behaviour Change Wheel to identify the barriers and facilitators to meeting guideline recommendations. Approximately half of the participants reported being aware of the guidelines (44.7%), 64.5% reported moderate knowledge of recommendations, and 27.6% of participants reported meeting guidelines for physical activity, sedentary behaviour, and sleep. Participants perceived factors associated with physical opportunities and psychological capabilities to have strong influences on their ability to meet movement behaviour guidelines. Recommendations for adapting 24-Hour Movement Guidelines for rural communities include providing additional information on being active outdoors and at home, information on discerning sedentary behaviour and inactivity, and tips to combat seasonal changes in daylight.

Background: Artificial intelligence (AI) continues to expand into nursing and health care. Many examples of AI applications driven by machine or deep learning are in use. Examples include wearable devices or alerts for risk prediction. AI tends to be promoted by nonnurses, creating a risk that AI is not designed to best serve registered nurses. Community health nurses (CHNs) are a small but essential group. CHNs’ familiarity with AI and their perceptions about its effect on their practice are unknown. Objective: The research aims to understand CHNs’ awareness, knowledge, and perceptions of AI in practice and gain insights to better involve them in AI. Methods: An online cross-sectional Canadian survey targeting CHNs was conducted from April to July 2023. Descriptive statistics summarized respondents’ characteristics and perceptions of AI, followed by a chi-square test used to determine a relationship between respondents’ level of AI knowledge and their AI perceptions, with odds ratio (OR) to determine the strength of association. Results: A total of 228 CHNs participated with varying response rates per question. Most respondents were female (172/188, 91.5%), average age of 45.5 (SD 11.7) years, and an average of 13.5 (SD 10.1) years of community practice experience. Most respondents (205/228, 89.9%) felt they welcomed technology into their practice. They reported their understanding of AI technologies as “good” (95/220, 43.2%) and “not good” (125/220, 56.8%). Overall, 39.6% (80/202) of respondents felt uncomfortable with the development of AI. They agreed that AI should be part of education (143/203, 70.4%), professional development (152/202, 75.2%), and that they should be consulted (195/203, 96.1%). Many respondents had concerns related to professional accountability if they accepted a wrong AI recommendation (157/202, 77.7%) or if they dismissed a correct AI recommendation (149/202, 73.8%). Respondents with “good” AI knowledge were significantly associated with, and twice as likely to indicate nursing will be revolutionized ( P =.007; OR 2.28, 95% CI 1.25-4.18), nursing will be more exciting ( P =.001; OR 2.52, 95% CI 1.42-4.47), health care will be more exciting ( P =.004; OR 2.3, 95% CI 1.30-4.06), and agreed that AI is part of nursing ( P =.01; OR 2.1, 95% CI 1.19-3.68). Respondents with “not good” AI knowledge were significantly associated with, and more likely to feel uncomfortable with AI developments ( χ ² ₁ =4.2, P =.04; OR 1.84, 95% CI 1.03-3.3). Conclusions: CHNs reporting “good” AI knowledge had more favorable perceptions toward AI. Overall, CHNs had professional concerns about accepting or dismissing AI recommendations. Potential solutions include educational resources to ensure that CHNs have a sound basis for AI in their practice, which would promote their comfort with AI. Further research should explore how CHNs could be better involved in all aspects of AI introduced into their practice.

Background: In recent years, there has been an increasing shift toward more collaborative approaches to research, with greater inclusion of diverse patients and community members in the research process. However, further exploration is needed to understand the factors that contribute to research partners feeling valued within teams. Gaining this insight could help foster supportive environments that empower these individuals to meaningfully contribute their expertise. Purpose: Our research aims to understand what makes patients and community partners, specifically those who experience barriers to engagement in research, feel valued in the patient-oriented research (POR) process. Methods: We conducted semi-structured interviews with 37 participants located in communities across British Columbia, Canada. Participants were identified as patients, community members, knowledge users, and researchers engaged in POR. Here, we draw specifically on the insights of 14 participants who identified as patient or community partners. Data were analyzed thematically, and an intersectionality lens was adopted to sensitize the research to the complexities and interactions of diverse and overlapping social locations in research. Results: Five themes emerged from our data analysis that focused on factors that make patient partners feel valued. These include: (1) building trusting relationships and communicating effectively, (2) respecting the patient partner’s expertise and recognition for their contributions, (3) working across diverse social spaces, (4) compensating and recognizing, and (5) taking a trauma-informed and culturally sensitive approach. Conclusions: Optimal patient engagement is vital for knowledge generation, with the potential to enrich research projects and their related impacts. Our research highlights factors that should be considered for a productive knowledge exchange in the context of patient-oriented research with patients from diverse communities.

Background/Objectives: Apathy, characterized by diminished motivation and reduced engagement in goal-directed behavior, is a prevalent concern among older adults, particularly in rural communities where opportunities for meaningful engagement may be limited. This study explores the preliminary impact of an in-person eBook club program on apathy among community-dwelling older adults in Northern British Columbia. Methods: This eight-week pilot single-group, pre-post mixed-methods study combined the use of eReaders to access weekly reading materials with facilitated in-person group discussions designed to foster emotional and social connection. Apathy was assessed using the 3-item Geriatric Depression Scale (GDS-3A) before and after the program. Results: A Wilcoxon signed-rank test revealed a statistically significant reduction in apathy scores (Z = −4.01, p < 0.001), with a large effect size (r = 0.76). While not powered for hypothesis testing, these findings suggest the program may have a meaningful effect. Qualitative analysis of participants who reported higher baseline apathy scores identified three key mechanisms of change: positivity effect, selective pruning of social networks, and adaptive coping, consistent with socioemotional selectivity theory. Conclusions: These preliminary results support the feasibility and potential value of theory-informed, low-cost group reading programs for addressing apathy in older adults and can inform the design of a larger, controlled study.