Relevant Degree Programs
Graduate Student Supervision
Doctoral Student Supervision (Jan 2008 - Mar 2019)
Background: Improved prenatal screening has resulted in significantly more parents facing a diagnosis of a fetal anomaly (FA). This experience can profoundly affect parents’ wellbeing and contribute to challenges in antenatal communication and decision-making. Research Purpose: To more fully understand: (1) the communication and decision-making dynamics associated with antenatal screening and the diagnosis of an FA; (2) the underlying frameworks and power relations shaping health care provider (HCP)-parent interactions; and (3) potential strategies for HCPs to support parental decision-making. Methods: Guided by a blend of critical and Foucauldian theoretical perspectives and a critical ethnographic approach, data collection occurred at two specialized women’s centres and involved over 275 hours of observational fieldwork and 119 hours of participant interviews. A diverse sample of 114 parent participants was recruited for 67 participant observation sessions. Informal interviews were conducted with all parents and in-depth formal interviews with 18 parent participants. Ten antenatal HCPs from a broad range of disciplines/subspecialties were also interviewed. Findings: (1) HCP-parent communication and decision-making is significantly shaped by dominant biomedical, efficiency, individualism, responsibilization and disability discourses in combination with underlying power relations. (2) A biomedical lens combined with organizational imperatives promoting brevity in HCP-parent interactions can result in parents’ needs not being addressed and thereby lead to increased parental distress, inadequately informed decisions and health inequities. (3) Despite HCPs’ nondirectional intentions, diagnostic and prognostic information is often presented in biased ways, which can lead to guarded HCP-parent interactions and increased parental distress. (4) Parents’ emotional responses to an FA are conceptualized as a complex matrix of prominent emotions vacillating between four intersecting continua: (i) dread/despair–hope; (ii) powerlessness–control; (iii) self-stigma–self-respect (and associated social isolation–social integration); and (iv) low parent-fetal attachment (PFA)–high PFA. Supportive interactions are those that facilitate parents to move their emotional stance toward hope, control, self-respect, social integration, and high PFA. Implications: Based on study results, I propose multi-level recommendations for antenatal communication and care practices, education programs and future research, with the ultimate goal of promoting excellence and equity in antenatal care delivery and HCP-parent communication and decision-making support.
Little is known regarding current relational dynamics among young people, their mental health, and socio-economic processes and implications for mental health promotion initiatives. Social praxis, underpinned by a Hegelian-Marxist historical-dialectical perspective was used to deepen understanding regarding ways that young people’s socio-economic environments are influencing their mental health, their processes of seeking to realize their mental health, and mental health promotion from a socio-economic perspective. The experiences of 30 diverse young people between the ages of 15 and 28 years were explored and compared to ways that socio-economic determinants of mental health are addressed within provincial mental health policy. There were four central findings in this study. First, participant reflections indicated eight inter-related mental health needs as having relevance in this current socio-economic context. Second, needs and affective experiences are important sites for deepening understanding regarding the inter-relation between young people’s mental health and socio-economic processes. Participant reflections illustrate the relational nature of mental health. They show how mental health is a phenomenon that emerges from the inter-relation between young people and the socio-economic processes that young people participate in within their day-to-day lives. Affective states indicate the degree to which a young person’s mental health needs are met, and play an inter-related role with socio-economic processes in influencing young people’s engagement in socio-economic processes as they seek to realize their needs. Third, there are several key ways that individualistic, wealth-oriented capitalist socio-economic practices and processes threaten young people’s mental health needs across the socio-economic spectrum. Fourth, young people’s control over realizing their mental health needs is limited by the ways they are oriented to seeking realization of their mental health within the inner and inter-personal contexts of their lives, despite the important role that socio-economic processes play in enabling their needs. A close reading of mental health policies shows their positioning in support of capitalist socio-economic processes. This limits the potential of mental health promotion in supporting synergistic relations between young people and socio-economic processes in realizing young people’s mental health. Based on insights gained from this study, I propose multi-level approaches for future praxis-oriented mental health promotion initiatives.
Master's Student Supervision (2010-2017)
Background: This study explores the perspectives of Champions of Cultural Safety and will potentially contribute to an Aboriginal Health team’s knowledge development of a current pilot project on Indigenous Cultural Competency transformation. This study identified healthcare providers (HCPs) who are Champions of Cultural Safety and explored their experiences practicing culturally safe care in their hospital. This study is timely given the current commitment to cultural safety and cultural humility in health services within the BC Tripartite Framework Agreement. Conducted with the guidance of the health authority’s Aboriginal Health Team, this inquiry may also assist HCPs in taking a cultural safety approach when providing healthcare in the face of ongoing racism and discrimination towards Indigenous people in healthcare and society. Methods: Using an exploratory, ethnographic, qualitative research design, recruitment began with Aboriginal Patient Navigators (APNs) who identified health care providers representing Champions of Cultural Safety. Snowball sampling was used until 8 participants from a variety of health care disciplines were recruited. Semi structured, in depth interviews were conducted with the APNs, an Elder and HCPs. Post-colonial theoretical perspectives informed the analysis and overall inquiry. A thematic analysis was conducted using constant comparison methods. Findings: The key findings are: 1) The client and health care provider relationship is the cornerstone of cultural safety (CS), 2) The organizational strategies to support CS are insufficient in the current, pervasive and conventional biomedical, organizational context, 3) Structural barriers to CS persist in the colonial context. These findings demonstrate the complexities and intersections of the HCP/client relationship, the organizational strategies to support CS and the current systemic barriers constraining the participants’ abilities to provide CS care. Discussion: The findings prompt three discussion areas: 1) The client and health care provider relationship is the cornerstone of CS, for both the client and health care provider when analyzed from a CS lens, 2) Many key characteristics of the hospital and wider health care context conflicts with a CS approach to care, 3) Structural violence characterized by racism and discrimination exists within the hospital environment, demonstrating a need for organizational interventions to address the continued Indigenous health inequities.
Background: Canadian Aboriginal children continue to be apprehended at a higher rate than non-Aboriginal children. Aboriginal mothers, who face significant social, political and economic disadvantage, are often under considerable scrutiny in relation to their parenting. Little is known about how the threat of child apprehension impacts the experiences of Aboriginal women accessing healthcare services. Therefore a study was undertaken to examine women’s perspectives on accessing health care when child apprehension is threatened. Methods: The study was guided by post-colonial feminist perspectives and followed the principles of exploratory, qualitative research design. Data collection and data analysis were carried out in two phases. Phase One involved a secondary analysis, using narrative interview data collected from a larger study (n=7). Phase One findings were used primarily to modify the interview guides developed for Phase Two. In Phase Two primary, face-to-face interviews were conducted with (i) Aboriginal women (N=9) and (ii) health care providers (n=8). Data was analyzed following the principles of thematic analysis and interpretive description. Findings: The findings indicated that women involved in the child protection system often experience complex socio-political and economic life challenges. The threat or fear of child apprehension did not impact the women’s decisions to seek medical services for their children; however the threat and fear impacted the women’s experiences with mainstream healthcare in a number of ways. Racism, prejudice, and discrimination within mainstream healthcare agencies along with the fear of child apprehension influenced the women’s decisions to access healthcare for themselves and impacted the women’s interactions with mainstream health care providers. In particular, women avoided engaging with health care providers when their children were hospitalized in part to protect themselves from judgment and discrimination. Discussion: Ongoing racism, judgment and discrimination toward Aboriginal mothers in mainstream healthcare agencies must be addressed. Health care providers working with Aboriginal people require education around culturally safe approaches to care and the history of colonialism and its effects on the health and well-being of Aboriginal people. Structural inequities such as poverty and discrimination must also be addressed through policy initiatives that attend to the social determinants of health.