Selected Research Projects
Improving access to family planning services for Indigenous peoples through storytelling: The Story Project
Role: Nominated Principal Applicant
Funders: Canadian Institutes of Health Research (2021-2025)
Abstract: The right to have children, not have children, and parent with dignity is central to the health and well-being of individuals, families, and communities. Respectfully supporting Indigenous peoples to plan and space their pregnancies is crucial to protecting this right in Canada. Indigenous communities are the holders of knowledge about what it means to have safe, culturally appropriate, and accessible family planning care. Data indicates that Indigenous clients routinely experience inequitable access, coercion, stigma, and reproductive violence when engaging with family planning care. Developing family planning programs and services that meet the physical, mental, emotional, and spiritual needs of Indigenous peoples first requires an understanding of their experiences with existing services.
This research, funded by a four-year CIHR Project Grant, is a collaboration between Indigenous communities, researchers at the University of British Columbia, the BC First Nations Health Authority, Vancouver Coastal Health Authority, the ekw'i7tl doula collective, and health care professional organizations. We aim to understand:
Indigenous peoples' experiences accessing family planning care and
What approaches to family planning care are best-suited to Indigenous communities, contexts, priorities, and needs.
We will gather stories from recipients and providers of care through one-on-one interviews that will be open-ended and conducted by community-based researchers trained in culturally-safe, trauma-informed research methods. We will use explore what "family planning" means to communities, what are clients' experiences of accessing family planning health services, how racism and stereotypes influence access to care, and what are the characteristics of good access to family planning for Indigenous clients. The results of this research will help fill the gap in knowledge about Indigenous experiences of current family planning care in Canada and will highlight opportunities for improved health service delivery.
Learn more: www.storyproject.ca
The Ask Us Project: Youth Voices to Improve Contraception Access
Role: Nominated Principal Applicant
Funders: Canadian Institutes of Health Research (2021-2025)
Abstract: The Ask Us Project is a two-part study taking place over four years. Phase 1 is an interview study with youth and service providers. The interviews are conducted by youth peer researchers. Through these interviews we are:
Investigating the experiences, beliefs, attitudes, knowledge, and contraceptive access needs of youth in Canada (aged 15 to 25) from the perspectives of youth and service providers, and
Identifying the attributes of contraceptive options that matter most when making decisions about methods to use, from the perspectives of youth and service providers.
After we complete the interviews, we will begin phase 2, a design project to create and test “youth stories.” These stories will communicate the results of our research to youth, health care professionals, and decision makers in Canadian contraception policy and practice.
Learn more: www.askusproject.ca
Navigating Sexual and Reproductive Health in BC : Perspectives of Im/migrant Youth
Role: Co-Principal Applicant
Funders: Canadian Institutes of Health Research - Early Career Investigator in Maternal, Reproductive, and Early Childhood Health (2021-24), UBC Community University Engagement Support Fund (2021-22), Mitacs (2022-24)
Abstract: Despite a large number of immigrant adolescents in Canada, there is limited research on the sexual and reproductive health service needs of this population. This qualitative study, conducted in collaboration with Dr. Salima Meherali (University of Alberta) and partners at Options for Sexual Health, will address these gaps by exploring the sexual and reproductive health priorities, information, and health service needs of immigrant and newcomer youth. We will engage in user-centred co-design activities to develop digital health tools to better link youth with resources that meet their identified needs.
Status: We have engaged in multiple rounds of priority-setting workshops with social service providers who serve immigrant and newcomer youth. We are about to initiate data collection with youth. Our study protocol was recently published here.
The Mifepristone Implementation Study
Role: Co-Applicant
Funders: Canadian Institutes of Health Research, Michael Smith Foundation for Health Research (2016-20); Women’s Health Research Institute (2019-20)
Abstract: Approximately one-third of Canadian women will have an abortion in their lifetime. About 100,000 occur annually, of which 96 percent are provided using surgery. Mifepristone medical abortion has the potential to increase women's access to abortion services. This integrated knowledge translation research seeks to understand the barriers and facilitators to implementation of mifepristone in Canada and draws on Greenhalgh's Diffusion of Innovation theoretical framework. I am a co-investigator on this research led by Dr. Wendy Norman (UBC).
With the Contraception and Abortion Research Team (CART-GRAC) based at BC Women's Hospital, I conduct research in the area of knowledge translation science (2016-present). Senior research investigators with the program have made significant impacts on increasing Canadian patients' access to mifepristone medical abortion and long-acting contraception methods. I study their integrated knowledge translation activities - knowledge brokering, policy dialogues, evidence reviews, media appearances - to determine the methods that facilitate uptake of best evidence into health service policy and practice. Our next steps will explore the implementation of medical abortion via telemedicine.
Status: We published manuscripts on factor influencing health service practice and policy for mifepristone access (Munro et al; Devane et al; Wagner et al; Guilbert et al), and of the characteristics of researcher-research user relationships that led to significant policy changes (Munro et al; Dineley et al).
A Patient Decision Aid for Method of Early Abortion
Role: Co-Principal Applicant
Funder: Health Canada (2023-24), IWK Health Centre (2021-22), Women’s Health Research Institute (2019-21)
Abstract: Canadians seeking to terminate an early pregnancy have two options: medication or procedural abortion. Both methods are very safe and each has unique benefits and drawbacks. When deciding on which type of abortion, people must consider various factors including their values as well as social resources and circumstances. Because of the time sensitive nature of abortion, patients must make their decisions quickly and often before they see their abortion provider. Together with Dr. Melissa Brooks, Dalhousie University, I lead a national user-centred design study to develop, test, implement, and evaluate an online interactive abortion method decision tool for patients seeking early abortion. Our patient decision aid, It’s My Choice, is the first tool of its kind in Canada.
Status: We have completed multiple rounds of user-centred design and testing, including cultural adaptation into French, Mandarin, and Punjabi. We have also conducted a randomized control trial to determine whether It’s My Choice leads to improvement in decision quality for people seeking early abortion. The tool will be launched on www.sexandu.ca in early 2024.
Right For Me: A Cluster Randomised Trial of Two Interventions for Facilitating Shared Decision-Making About Contraceptive Methods
Role: Co-Applicant
Funder: Patient Centred Outcomes Research Institute (2014-17)
Abstract: In the United States, over half of all pregnancies are unintended. Unintended pregnancy often occurs because women do not have a contraceptive method that fits their needs and lifestyle. The purpose of this research was to learn the best way to support women and their providers as they together compare contraceptive methods and choose a method based on what matters most to the woman. The Right for Me study was a large multi-centre randomized control trial in the eastern US that aims to improve shared conversations about birth control methods between patients and providers. It was led by Dr. Rachel Thompson at Dartmouth College, involved patients as partners in all stages of the research process, and was funded by the Patient-Centered Outcomes Research Institute. I conducted the qualitative evaluation of the implementation of the shared decision-making interventions, informed by the Theoretical Domains Framework. The evaluation explored how clinics implemented the shared decision-making interventions. This evidence will help policy makers and researchers understand what strategies are best for implementing shared decision-making into routine care.
Status: The results of my qualitative evaluation were published in Implementation Science and can be read here.