Kathryn A. Birnie

BACKGROUND Pediatric Acute Pain Services (APSs) are specialized teams that manage complex acute pain in children during hospitalization. Despite their widespread establishment in children’s hospitals worldwide, significant gaps in pain management practices and disparities in care persist, particularly among marginalized populations. The Canadian Pediatric Pain Management National Health Standard (CPPM-NHS) provides a framework for promoting safe, effective, and equitable acute pain care. By embedding the CPPM-NHS within a Learning Health System (LHS) framework, pediatric APSs can leverage real time data and continuous feedback to promote clear, equity-oriented metrics that enhance care delivery. However, there is a significant lack of literature that explicitly describes the operationalization of LHSs specifically within the APS context. OBJECTIVE This scoping review aims to map the extent, range, and nature of the evidence describing the operationalization and capacity of LHSs within pediatric APSs. Specifically, this review will identify reported practices, frameworks, and capacity-building components that align with the delivery of effective, safe, and equitable acute pain care. METHODS Following JBI methodology and the PRISMA-ScR checklist, we will search eight electronic databases and grey literature. Data extraction will involve a structured charting process to map identified LHS components (categorized by LHS Learning Cycles and LHS Enabling Environments Framework) against quality pain domains and equity indicators (categorized by the CPPM-NHS and PROGRESS Plus framework). Through cross-tabulation and content analysis, we will descriptively illustrate how specific LHS components are utilized to promote quality pain care. Findings will be presented through narrative summaries and a tree map to visualize the alignment between LHS activity and quality pain care indicators. RESULTS A preliminary search has identified 674 articles, and we will finalize our search strategy in collaboration with two health sciences librarians through the Peer Review of Electronic Search Strategies (PRESS) review approach. The results will be presented as a narrative summary and visual tree map to highlight the distribution of LHS practices across the pediatric APS landscape. CONCLUSIONS This scoping review will provide a comprehensive landscape analysis of LHS operationalization and capacity in pediatric APSs. By identifying existing gaps and strengths, the findings will inform future efforts to enhance acute pain management for children, ultimately leading to more effective, safe, and equitable delivery of acute pain care.

BACKGROUND Given significant advances in medical treatment and technology in recent decades, increasing numbers of children with health conditions are living longer and most will require transition from pediatric to adult care. Many youth and their caregivers experience challenges during this transition, leading to adverse health outcomes. In response, transition in care (TiC) has been identified as a priority health system issue in Canada. Substantial investments have promoted the development of TiC innovations to improve the transition from pediatric to adult care. However, these TiC innovations are rarely implemented or sustained in practice. Knowledge translation (KT) interventions are strategies designed to promote the uptake of innovations into clinical practice. Despite a growing body of evidence KT interventions and TiC innovations, little is known about what, when, and how KT interventions influence the implementation and sustainability of TiC innovations. OBJECTIVE This mixed methods realist evaluation will examine what, when, how, and under what contexts KT interventions work or do not work to support the implementation and sustainability of TiC innovations for youth transitioning from pediatric to adult care. METHODS Guided by realist methodology, the study comprises three phases. An integrated knowledge translation approach is used to actively involve people with lived and professional experience of TiC throughout the study. In Phase 1, we will conduct a realist review to identify KT interventions and develop initial program theories. In Phase 2, we will test and refine these initial program theories through a realist evaluation, using a multiple comparative case study design, leveraging three real-world TiC innovation cases in Alberta, Ontario, and Nova Scotia. In Phase 3, we will host a knowledge exchange event to co-design recommendations for using KT interventions to support the implementation and sustainability of TiC innovations. RESULTS This is study is funded by the Canadian Institutes of Health Research, starting in January 2026. Scientific and Research Partner Teams have been established with representation from across Canada. Terms of reference have been co-developed to guide engagement with youth, caregivers, healthcare professionals, health system leaders, and community partners. The total project duration is anticipated to be three years. CONCLUSIONS Using a theory-driven realist approach, this study will test and generate refined program theories explaining what, when, how, and under what contexts KT interventions work, or do not work, to implement and sustain TiC innovations. These theories will inform the co-development of recommendations, with the potential to reduce research waste and support the use and adaptation of KT interventions across different health conditions and settings in Canada and internationally.

BACKGROUND Virtual self-management programs for pediatric autoimmune diseases combine digital content, participant activity, and human support. Understanding whether their intended components are delivered, received, and enacted requires fidelity evidence that is distinguishable from platform use and clinical outcomes. OBJECTIVE To map how intervention and implementation-strategy fidelity are defined, assessed, and reported in virtual self-management programs for pediatric autoimmune diseases, and distinguish fidelity evidence from related process and outcome measures. METHODS Guided by the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR), we searched six databases (2002–2026) for peer-reviewed articles involving pediatric autoimmune populations and relevant fidelity measures, assessment procedures, implementation strategies, or quality-assurance processes. Synthesis was informed by the Dunst framework, the Consolidated Framework for Implementation Research (CFIR), and the Expert Recommendations for Implementing Change (ERIC) taxonomy. Direct fidelity assessments were distinguished from participation indicators, acceptability and usability measures, and health outcomes. RESULTS Of 284 identified records, 39 articles were included: 25 addressing type 1 diabetes, 7 inflammatory bowel disease, 5 juvenile idiopathic arthritis, 1 systemic lupus erythematosus, and 1 mixed rheumatic-disease population. Direct fidelity evidence included interventionist checklists, recorded-session review, automated treatment-integrity controls, competency assessment, and structured delivery-standardization procedures. Other articles contributed intended-dose, attendance, module or app use, engagement, acceptability, and usability indicators. Two trial design/baseline articles contributed fidelity procedures without final effectiveness findings. Fidelity to implementation strategies was not consistently distinguished from fidelity to intervention delivery, and the heterogeneous evidence did not establish that higher fidelity caused better outcomes. CONCLUSIONS This review adds a cross-modality account of what reported fidelity procedures and indicators establish in virtual pediatric autoimmune self-management. Separating intended standards, assessment procedures, observed delivery, receipt and enactment, implementation support, and patient outcomes can support interpretation, replication, and service planning. The synthesis does not establish that higher fidelity causes better outcomes. CLINICALTRIAL N/A

Background: Chronic pain affects approximately 20% of children and youth worldwide and is associated with mental and physical health impacts. Canada-specific data on the prevalence of chronic pain in children and youth are limited, highlighting the need for current high-quality population-based estimates Aims: The aim of this study is to provide national estimates of self-reported chronic pain among Canadian children and youth by pain type (headache stomach ache, backache), sex (female, male), age group (5-11, 12-17 years) and province or territory. Methods: Publicly available data were used from the 2019 Canadian Health Survey on Children and Youth (CHSCY), a population-based survey conducted by Statistics Canada using a nationally representative sample of Canadian children and youth Results: Overall, headaches were the most commonly reported pain type (15.4%), followed by stomach aches (12.5%), and backaches (11.1%). Prevalence was consistently higher among females than males and among youth than children, with youth girls reporting the highest prevalence across all pain types. Prevalence also varied geographically, with some of the highest estimates observed in the Atlantic Provinces. Conclusions: Chronic pain affects substantial proportions of Canadian children and youth with disparities observed by pain type, sex, age, and geography. These findings under score pediatric chronic pain as an important public health issue and highlight the need for equity-oriented approaches that address the needs of populations experiencing the greatest burden.

Background: Research suggests that media consumption plays a role in socialization, including the socialization of painful experiences. Findings from previous research examining pain depictions in popular adolescent media suggest that violence and injuries are frequently represented, marginalized populations are underrepresented, and observers lack prosocial responses to sufferers' pain. This study was the first to examine how adolescents perceive, internalize, and discuss pain depictions in popular adolescent media. Methods: Fourteen adolescents (between 13 and 18 years of age), both with and without chronic pain, participated in focus groups. Participants watched clips depicting pain in popular adolescent media before providing their feedback. Results: Using reflexive thematic analysis, three themes were generated: (1) a failure to communicate, but not to empathize—observers may be fearful or lack the tools and confidence to address sufferer pain, (2) media as the metric—media serves as the metric by which we can compare pain experiences, which may contribute to stigma and disbelief, and (3) media as the conduit for transformation—media may be harnessed to properly represent and build empathy for pain. Significance: These novel findings suggest that media portrayals of pain may shape youths' beliefs about pain expression, validation, and empathy. Media could therefore serve as a modifiable target for reducing pain‐related stigma and improving empathic responses to pain.

Objective: To examine the social experiences of youth with Juvenile idiopathic arthritis (JIA). Methods: This systematic review synthesizes findings from 18 qualitative studies (2014–2024) based on a search from four databases (Scopus, PubMed, Web of Science, and PsycINFO). The studies were assessed for quality using the Critical Appraisal Skills Programme Qualitative Checklist (CASP, 2024). Results: Six key themes emerged: (1) Physical Barriers to Social Interaction, (2) Lack of Understanding from Others, (3) Enacted Stigma, (4) Anticipated Stigma, (5) Internalized Stigma, and (6) Resources. Conclusions: The review findings support increasing public awareness, fostering peer support, enhancing self-advocacy skills, and implementing stigma-reduction strategies to better support the social functioning of youth with JIA. Future research should explore long-term effects of stigma and evaluate targeted interventions to improve social experiences and quality of life for this population.

Background: Supporting youth and their caregivers during the transition from pediatric to adult health care is a priority across Canada. Many transition in care (TiC) innovations exist, yet these innovations often fail to be effectively implemented and/or sustained. Knowledge translation (KT) interventions, such as developing educational materials and identifying champions, are used to promote the uptake of innovations into clinical practice. However, there is limited information on what, when, and how these KT interventions are used to implement and sustain TiC innovations. Objective: This paper presents the protocol for a realist review aiming to understand what KT interventions work, how they work, for whom, and under what circumstances to support the implementation and sustainability of TiC innovations for youth moving from pediatric to adult health care. The objectives are to (1) identify and map KT interventions and (2) develop initial program theories. Methods: We will follow Pawson’s 5 iterative steps for realist reviews, integrating aspects of rapid realist review methodology. We will adhere to the RAMESES (Realist and Meta-narrative Evidence Syntheses–Evolving Standards) quality standards for realist synthesis. Using an integrated KT approach, we will leverage the lived and professional expertise of a team of knowledge users and researchers. Results: This project has received funding from Canadian Institutes of Health Research, starting in January 2026. A research partner team of 24 people with lived and professional expertise in transition has been assembled, as well as a team of 18 scientific members. Step 1 of the review is underway. The review is anticipated to be completed within 12 months. Conclusions: Using a theory-driven approach, this realist review will result in initial program theories about the underlying mechanisms, contextual factors, and processes within KT interventions that influence implementation and sustainability outcomes of TiC innovations for youth and their caregivers. A subsequent explanatory mixed methods realist evaluation with a multiple comparative case study design will test and refine initial theories. This research will be important to inform future TiC innovations for diverse health contexts across Canada and beyond.

BACKGROUND Supporting youth and their caregivers during the transition from pediatric to adult health care is a priority across Canada. Many transition in care (TiC) innovations exist, yet these innovations often fail to be effectively implemented and/or sustained. Knowledge translation (KT) interventions (e.g., education and clinical champions) are used to promote the uptake of innovations into clinical practice. However, there is limited information on what, when, and how these KT interventions are used to implement and sustain TiC innovations. OBJECTIVE This paper presents the protocol for a realist review aiming to understand what KT interventions work, how they work, for whom, and under what circumstances to support the implementation and sustainability of TiC innovations for youth moving from pediatric to adult healthcare. The objectives are to 1) identify and map KT interventions, and 2) develop initial program theories. METHODS We will follow Pawson’s five iterative steps for realist reviews, integrating aspects of rapid realist review methodology. We will adhere to the Realist and Meta-narrative Evidence Syntheses – Evolving Standards (RAMESES) quality standards for realist synthesis. Using an integrated knowledge translation approach, we will leverage the lived and professional expertise of a team of knowledge users and researchers. RESULTS A Research Partner team of people with lived and professional expertise in transition has been assembled. Step 1 of the review is underway. We anticipate the timeframe for completion will be twelve months. CONCLUSIONS Using a theory-driven approach, this realist review will result in initial program theories about the underlying mechanisms, contextual factors, and processes within KT interventions that influence implementation and sustainability outcomes of TiC innovations for youth and their caregivers. A subsequent explanatory mixed methods realist evaluation with a multiple comparative case study design will test and refine initial theories. This research will be important to inform future TiC innovations for diverse health contexts across Canada and beyond.