Valorie A. Crooks

Older populations globally are experiencing a rise in sexually transmitted infections, and those who travel internationally and engage in unsafe sex practices are particularly at risk. International retirement migrants, who live abroad for extended periods each year, pose unique challenges for public health efforts to prevent, track, control, and treat these infections. To date, no research has examined the specific opportunities and challenges for sexually transmitted infection prevention among Canadian international retirement migrants who winter in the United States. This study addresses that gap by drawing on local providers’ and administrators’ perspectives from Yuma, Arizona, a popular winter destination for older Canadian retirees, and exploring opportunities and challenges for sexual health promotion for older mobile populations. Using a qualitative case study approach, we conducted semi-structured interviews with key informants with deeply situated expertise in Yuma (n = 10), including public health and health care providers and senior administrative professionals. Participants shared their insights based on their extensive experience treating or administering care for collectively hundreds of Canadian winter visitors. Interviews were transcribed verbatim, coded using NVivo, and thematically analyzed. Opportunities and challenges that emerged were connected to three distinct pathways: system, community, and individual. Opportunities included leveraging telehealth tools and outreach initiatives to increase awareness of sexually transmitted infection prevention, fostering local partnerships to destigmatize sexual health discussions, and promoting awareness and testing for sexually transmitted infections. Challenges included travel insurance limitations and digital literacy issues among Canadian retirees, staff shortages that limited public health outreach, cross-border care coordination challenges, and inadequate education among medical providers to support discussions of sexual health with older adults. This analysis highlights multiple significant opportunities and challenges in improving sexually transmitted infection prevention efforts for Canadian older seasonal migrants in Yuma, Arizona. Addressing these barriers and leveraging opportunities to inform sexual health educational outreach into retirement communities is crucial for public health and health system decision-makers to reduce disease spread and the heavy seasonal demand on the local health system. The online version contains supplementary material available at 10.1186/s12889-026-27455-5.

Global medical missions deliver essential health care services to equity-seeking communities, and particularly in the Global South. While medical missions

Background: Medical crowdfunding, a type of donation-based crowdfunding, is gaining prominence and enabling people to gather funds for medical treatments, surgeries, and other health needs. While this practice may democratize access to health care, it also raises ethical concerns, including breaching individuals’ privacy. Despite these concerns, little consideration has been given specifically to the privacy-related issues that emerge when people crowdfund on behalf of others’ health-related financial needs. Methods: A study was undertaken to qualitatively explore the roles and associated role responsibilities of Canadians who crowdfund on behalf of others for their health needs. Twelve interviews were conducted with participants who had posted campaigns on the GoFundMe platform between January and December 2023. Interviews were transcribed, coded, and analyzed thematically. Findings: Three key roles that had important privacy dimensions were identified: managing initial content, navigating informational considerations, and facilitating ongoing connections. Campaigners typically collaborated with recipients to craft compelling narratives, seek consent for sharing personal information, and provide regular updates to maintain donor engagement. Balancing campaign transparency with recipients’ privacy concerns was crucial in the crowdfunding process. Conclusion: Campaigners play pivotal roles in medical crowdfunding when doing so on behalf of funding recipients, including balancing the need for fundraising with the protection of recipients’ privacy. Clear guidelines are needed to support campaigners in navigating the ethical complexities that emerge. Further research is needed to address existing knowledge gaps and enhance the ethical integrity of crowdfunding practices.

Background: Within long-term care (LTC) homes, telehealth use has been found to reduce unnecessary emergency department transfers, support the care needs of rural and underserved communities, and supplement in-person physician care. Despite these benefits, it is not well understood when telehealth is not an appropriate medium for providing physician care to residents with complex health needs. This knowledge gap must be addressed given the recent rise in telehealth use in LTC homes in many health systems following the COVID-19 pandemic, when virtual care use increased in many health care sectors to limit travel and in-person exposure risks, that is expected to be maintained going forward. Methods: This analysis contributes to a broader evaluative study investigating care provider and care recipient experiences and preferences for physician telehealth in LTC homes within the Fraser Health region in British Columbia, Canada. For data collection, semi-structured interviews and focus groups were undertaken with seventy care providers (staff, physicians) and recipients (residents, family caregivers). Using a thematic approach, transcripts were analyzed to find common instances when using telehealth for physician care was seen as not appropriate across participant groups. Results: Three types of patient care activities were identified as not appropriate to be conducted via physician visits using telehealth. First, new patient visits were thought to benefit from an interpersonal and conversational familiarity that could not be supported by telehealth. Second, difficult in-depth conversations that required conversational nuance (e.g., eye contact, supportive body language), such as palliative care planning, were thought to be inappropriate for telehealth appointments. Finally, instances where LTC staff would need to perform hands-on clinical assessments on behalf of physicians who were attending virtually via telehealth were not seen as desirable. Conclusions: This analysis highlights perspectives surrounding when telehealth is not appropriate for providing physician services for residents in LTC based on the preferences and experiences shared by both care recipients and care providers. The findings present an opportunity to develop and implement guidelines on appropriate use of telehealth in LTC to support best care practices.

Background: Sexually transmitted infections are on the rise in older populations globally, including among older travellers. International retirement migrants are older people who have retired from the workforce and travel abroad seasonally, typically during the winter months in their home countries. The transnational nature of this practice may challenge public health efforts to control the spread of sexually transmitted infection and encourage treatment. This study focuses on Yuma, Arizona, a popular destination for Canadian international retirement migrants who winter in the United States, to examine the sexual health risks associated with their seasonal travel. Methods: Utilizing a qualitative case study approach, this research involved semi-structured interviews conducted remotely with key informants in Yuma (n = 10) who held various health care and administrative roles. Participants provided insights into sexual health risks based on their extensive interactions with Canadian seasonal migrants and their knowledge of the social dynamics within retirement communities. Interviews were transcribed verbatim, coded using NVivo software, and thematically analyzed to identify risk factors for sexually transmitted infections among Canadian international retirement migrants wintering in Yuma. Results: Findings revealed three main risks that may contribute to exposure to sexually transmitted infections and potential transmission: social dynamics within tight-knit retirement migrant communities that facilitate unsafe sexual practices (i.e., risky practices); barriers to accessing diagnostic services, such as costs and lack of established local care (i.e., risky care access); and challenges in following standard treatment and public health protocols due to logistical difficulties in ensuring follow-up (i.e., risky treatment decisions). Key informants noted that lifestyle choices, including the use of alcohol and drugs, can exacerbate these risks. Health care access barriers driven by travel health insurance and mobility limitations further complicate the diagnosis and treatment of sexually transmitted infections for Canadian international retirement migrants while abroad. Conclusions: This study highlights the complex interplay of social behaviours and health care barriers that heighten the risk of sexually transmitted infection transmission among Canadian retirement migrants in the transnational context of Yuma. Extended diagnostic and treatment services, comprehensive sexual health education in pre- and post-travel consultations, as well as inclusive travel health insurance coverage could significantly improve the sexual health outcomes for this population.

Over the last twenty years knowledge mobilization (KM) is increasingly a priority for researchers, funders, and universities. As KM emphasizes non-traditional forms of mobilization and encourages approaching research differently (e.g. co-production) there is a natural fit with advancements in academic librarianship such as digital scholarship. The goal of KM is to increase the use and positive impact of research beyond academia. Many researchers, required to plan and do KM as part of the funding requirements, need additional supports to learn about and mobilize their research beyond traditional approaches; academic institutions are responding with developing support services or roles in the institution. Approaches to these services are diverse, some centralized, some faculty or department specific, some dedicated roles, others added on to existing roles. In this paper we describe a pilot project to support KM at one Canadian university. Specifically, we share the development, initiation, and program model of a KM support unit within an academic library. We make the case for the importance of physical location of this type of service, the value the library adds to this service, and other lessons learned through this pilot project.

Background: Early in the COVID-19 pandemic, long-term care (LTC) homes in British Columbia, Canada, restricted visitation to ensure the safety of their residents against transmission of the novel coronavirus. As such, these LTC homes had to quickly implement a rapid rollout of telehealth services to maintain physician care for residents while avoiding the infection risk of in-person visits amidst lockdown measures. The abrupt transition from traditional in-person physician care to telehealth presented significant challenges. Investigating these challenges is pivotal to the development of strategies for sustained telehealth use for physician services in LTC homes. This analysis is part of a broader qualitative, utilization-focused evaluation study of telehealth services rapidly implemented for physician care in LTC homes within the Fraser Health Authority region of British Columbia. The evaluation has aimed to consider integral factors such as telehealth challenges, facilitators, preferences, and continued use. Semi-structured interviews and focus groups were conducted with 70 physicians, staff, residents, and family caregivers across 27 different LTC homes in the region. All interviews and focus groups were transcribed verbatim and were analyzed using a thematic approach to identify common barriers surrounding the rapid rollout of telehealth in LTC across relevant groups. Results: From the data, four challenges were identified: connectivity challenges (e.g., inconsistent or no Wi-Fi or cellular connectivity), device challenges (e.g., lack of accessible devices and software issues), privacy challenges (e.g., lack of private space to support telehealth use), and informational challenges (e.g., lack of electronic medical record access). All challenges posed barriers to telehealth access for both care provider and recipient groups in LTC settings. Conclusions: The challenges identified in this analysis are supported by existing literature, which is significant given the different contexts within which such research has been undertaken. Collectively, this knowledge base can support evidence-informed improvements to telehealth for physician care in LTC settings. Future research should capture the perspectives of diverse cultural groups, LTC residents with cognitive impairments, and those who provide and receive care in rural settings.

Background: International retirement migration, which is the seasonal or permanent relocation of older people to another country, has grown in popularity in recent years. These retirees are motivated by the promise of warmer winter climates that are conducive to participating in health-promoting recreational and social activities. Ease of cross-border travel facilitates this transnational practice when undertaken seasonally. However, border closures and other travel-related measures put in place to manage the spread of COVID-19, disrupted travel, including for older Canadians who typically winter in the United States (US). During the 2020-21 winter season, for example, Canadians were advised not to engage in non-essential international travel and the land border between Canada and the US was closed to all but essential travellers. Nonetheless, retirement migration remained a significant draw for many Canadian retirees. Here, we qualitatively explore the factors that Canadian international retirement migrants considered when deciding whether or not to travel to the US for the 2020-21 winter during the COVID-19 pandemic. Methods: Guided by case study methodology, semi-structured interviews were conducted with 31 Canadian international retirement migrants who had wintered in the US prior to the COVID-19 pandemic and were in the US at the outset of the pandemic in late winter 2020. Interviews were transcribed verbatim and thematically analyzed to decipher what factors were most important to their travel-related decision-making during the pandemic. We structure the thematic results around four factors previously identified to motivate older people to become international retirement migrants and thus inform decision-making: the destination, the people, the cost, and the movement. Results: The previously identified factors that motivate older people to participate in international retirement migration include: the destination (e.g., climate and amenities), the people (e.g., social networks), the cost (e.g., health insurance and living costs), and the movement (e.g., ease of travel). These factors informed how international retirement migrants made decisions to travel abroad or not in the 2020-21 winter season. For example, destination-based factors included a lack of public health measures and high case counts, people-based factors comprised of less opportunities to engage in social activities, cost-based factors involved maintaining property investments and the lack of COVID-19 treatment coverage in available travel health insurance plans, and movement-based factors included challenges in ease of access when travel was viewed as essential or non-essential. These factors disincentivized or motivated international retirement migrants to travel abroad in the 2020-21 winter season during the COVID-19 pandemic. Conclusions: The results of this study support the need to create tailored decision-support tools for international retirement migrants to make informed travel-related decisions during crisis events so as to protect their health and wellbeing. More research is needed to explore perceptions of risk, especially health risks, among international retirement migrants and how they differently affect their travel-related decisions.