Relevant Degree Programs
Graduate Student Supervision
Doctoral Student Supervision (Jan 2008 - May 2021)
Background: Clinical practice guidelines indicate that over 80% of women with a previous caesarean should be offered a planned vaginal birth after caesarean (VBAC), however only one third of eligible women choose to plan a VBAC. Shared decision-making (SDM) interventions support women to make choices based on their informed preferences. To facilitate implementation of SDM it is necessary to understand the patient (micro), health services (meso), and policy (macro) factors that influence decision-making. Objectives: My objective is to explore attitudes toward and experiences with decision-making for mode of birth after caesarean section in British Columbia (BC) to identify factors that influence implementation of SDM. Methods: In-depth, semi-structured interviews were conducted with women eligible for VBAC, care providers, and health service decision makers recruited from three rural and two urban BC communities. Integrated knowledge translation (iKT) principles guided study design, while constructivist grounded theory informed iterative data collection and analysis. Findings were interpreted using complex adaptive systems theory (CAS). Results: Analysis of interviews (n=57) and CAS interpretation revealed that the factors influencing decisions resulted from interactions between the micro, meso, and macro levels of the health care system. Women formed early preferences for mode of delivery (after the primary caesarean) through careful deliberation of the social risks and benefits of mode of delivery. Physicians acted as information providers of clinical risks and benefits, with limited discussion of patient preferences. Decision makers serving large hospitals revealed concerns related to liability and patient safety. These stemmed from limited access to surgical resources, which had resulted from budget constraints. To facilitate mutual understanding among stakeholder groups, iKT activities included policy dialogues and the creation of a policy brief. Conclusion: To facilitate the effective implementation of SDM in clinical practice for mode of delivery after a previous caesarean section, it is necessary to address the needs of women, care providers, and decision makers. These include initiating decision support immediately after the primary caesarean, assisting women to address the social risks that influence their preferences, managing perceptions of risk related to patient safety and litigation among physicians, and access to surgical resources.
Master's Student Supervision (2010 - 2020)
Women living in rural First Nations communities face challenges accessing adequate nutrition and nutrition care during pregnancy, creating a barrier to achieving optimal maternal, fetal and newborn health outcomes. Key policy documents have highlighted the importance of understanding and giving voice to First Nation women with regard to antenatal programming including nutrition care. First Nation communities are marked by low rates of recruitment and retention of health care providers, as these professionals are often required to provider a broader scope of practice and have a higher workload than their urban counterparts. Understanding both women and provider perspectives is a key step to improving efficacy of antenatal services. This qualitative project is a collaboration between First Nations Health Authority, Haisla Nation, and The University of British Columbia. Using a community-centric, case study framework, we explored the experiences of the birthing population and care providers of accessing and providing nutrition care and programs within the Northern community of Kitamaat Village (Haisla Nation), British Columbia. Data collection consisted of open-ended interviews with 13 pregnant or recently pregnant women and 4 care providers within Haisla Nation. The lead researcher transcribed interview transcripts verbatim and textual data was analyzed using qualitative computer software (nVivo, QRS International Pty. Ltd). Transcripts underwent inductive coding and thematic analysis according to Braun and Clarke. Main themes that resulted from analysis included the perceived value and experience of current antenatal nutrition programs; lack of nutrition advice provided within primary care setting; the role for nutrition specialist within Haisla Nation; and the importance of traditional foods and practices during pregnancy. By gaining insight on how nutrition care is accessed, perceived and provided within Haisla Nation using a community centric model we are able to use the knowledge gained to further the provision of nutrition care during the antenatal period for First Nation women. The success of current programs within this community, as well as the process developed to understand the on the ground experiences have potential to be adapted in other First Nation communities in British Columbia to tailor prenatal nutrition programming across the province.