Browsing by Author "Mou, Haizhen"

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Open Access
Assessing Value in Upstream Health Interventions: A Case Study of the Dr. Paul Schwann Centre Cardiac Rehabilitation Program
(Faculty of Graduate Studies and Research, University of Regina, 2015-07) Beck, Caroline Anna; Marchildon, Gregory; Zhang, Lihui; Zarzeczny, Amy; Mou, Haizhen; Daschuk, James
In the past several decades, a major ideological shift has occurred regarding the relative importance of broad socioeconomic factors as determinants of health over access to conventional health services. During this time, public health experts have continually re-emphasized the need to focus attention further “upstream” of disease, in order to prevent populations from developing poor health. While provincial health systems currently integrate some population and public health programming within the basket of services they offer, upstream health interventions represent only a very small proportion. While many factors can explain this pattern, one explanation is key; upstream health interventions must compete against conventional “downstream” services for a single funding pool, and in this evaluation process, three unique challenges arise. First, there must be a convincing argument that governments should intervene in these private markets to produce a socially optimal outcome. Second, there are unique challenges that arise in measuring the outcomes of upstream interventions, as upstream interventions tend to relate to broader social values that occur over the long-term rather than immediate, quantifiable improvements in health. Third, there have been structural challenges within the system of healthcare administration in Canada. As a result of these three challenges, upstream health interventions are often undervalued and can become subject to great financial instability. This is demonstrated by one upstream program in the Regina Qu’Appelle Health Region – the Dr. Paul Schwann Centre Cardiac Rehabilitation Program. This research investigates the policy problem of assessing value in upstream interventions through a case study of this upstream health intervention. Through a three-pronged analysis of program-level data, this thesis explores the question of how evidence in preventative health interventions can be synthesized with greater policy relevance to inform the reallocation of scarce healthcare dollars from downstream illness care interventions to the upstream. To explore these policy-relevant dimensions – effectiveness, client experience, and cost-effectiveness – three methodologies were used: (1) a quantitative analysis of available client health data to assess changes in health status throughout the program’s duration; (2) qualitative interviews with clients and staff to assess perceptions of experience, health impact, and overall value for money in the program; and (3) quantitative assessment of cost-effectiveness using economic evaluation techniques to allow for comparison to other health interventions. By comparing the results of these assessments to other studies from the literature, lessons were drawn regarding the potential health system value of such a program for the regional health system. While various methodological and data-related limitations must be recognized, this study demonstrates the ability to overcome some traditional challenges in the evaluation of upstream health interventions. As one example of this type of evaluation, this research acts as a guiding example for future studies examining health systems value of upstream interventions. By using multiple dimensions of relevance to policy and decision-making, findings of this research suggest that the use of mixed method research and evaluation methodologies may best illuminate the broader social and health-related outcomes of prevention-oriented programs in addition to their quantifiable outcomes.
Open Access
Canada's Public Schools: Are we paying more but getting less?
(2019-04) Marshall, Jim; Mou, Haizhen; Atkinson, Michael
The question of value for money is central to any public policy consideration. Given its scale, coupled with its critical social and economic impact, education ranks as one of the most important and challenging policies for analysis.
Open Access
Determining the Impact of Telehealth on Rural and Remote Health Care Service Delivery in Canada
(Faculty of Graduate Studies and Research, University of Regina, 2014-03) Hill, Kimberly Anne; Marchildon, Gregory; Zhang, Lihui; Mou, Haizhen; Jeffery, Bonnie
There are disparities in health status and outcomes between rural and remote residents and their urban counterparts, and these disparities are caused in part by inequitable access to health services. For decades provincial and territorial decision makers have implemented numerous health human resource policies, most commonly financial incentives, to attract health providers to rural and remote areas to alleviate the inequity of access. The effect of these policies has been temporary in that health providers responding to these incentives rarely established permanent practices in rural and remote communities. In addition, these policies rarely address the fact that specialized health services and infrastructure are highly concentrated in urban centres. In recent decades, decision makers have explored the use of information and communication technology via provincial and regional telehealth programs to provide more specialized health services that were previously unavailable in underserviced communities. Using the widely adopted Triple Aim framework developed by the Institute for Healthcare Improvement, three modes of telehealth (telemedicine, health help lines, and online mental health therapy) are evaluated for their ability to simultaneously improve population health through improved access and improve the patient experience in rural and remote areas while maintaining or decreasing the per capita costs of health care. The analysis showed that telehelath does have the ability to improve access to health services, but low utilization, especially among provinces with high percent rurality, would indicate that its impact on access has been minimal. Additionally, there is evidence that health help lines may actually increase disparities by increasing the number of unnecessary visits to physicians and emergency departments. Data on changes in health status as a result of telehealth use is not available, and health outcomes have only been assessed as part of pilot projects and thus are not generalizable to telehealth as a whole. To date studies evaluating the cost savings of telehealth have been flawed and thus no determination could be made regarding telehealth’s ability to decrease the cost of care of rural and remote residents. Although telehealth has had minimal impact on improving access to care of rural and remote residence, research does demonstrate its promise in delivering care at a distance. Policies are in place to enable its use more broadly, but most jurisdictions lack implementation strategies that elicit the growth of telehealth. Jurisdictions must work together to collectively define telehealth, determine its goals and objectives, and then assign appropriate modes of telehealth to meet the needs of the population being served. Additionally, provincial and territorial telehealth programs would benefit from rigorous program evaluations and academic research to ensure effective service provision. Most importantly, provincial telehealth programing would benefit from the creation of a centralized governance structure whereby economies of scale can be leveraged in the procurement of technology, provision of consistent training and technical support, and coordination of care across the province or territory. Telehealth programing is a mechanism by which provincial and territorial health ministries can use to improve service provision in rural and remote areas, but more work is needed to translate telehealth’s potential benefits into realized gains for rural and remote residents.
Open Access
Election 2015: Economic, Political and Policy Consequences
(Johnson Shoyama Graduate School of Public Policy, 2015-10-21) Atkinson, Michael; Béland, Daniel; Courtney, John; Mou, Haizhen
Open Access
Examining Initial Perception of Internet-Delivered Cognitive Behavioural Therapy Through Lens of Attutinal Structural, and Computer Barriers
(Faculty of Graduate Studies and Research, University of Regina, 2019-02) Moskalenko, Maryna Yevheniv; Katapally, Tarun; Hadjistavropoulos, Heather; Mou, Haizhen; Novik, Nuelle
Interned Cognitive Behavioural Therapy (ICBT) for depressive and anxiety symptoms provides flexibility, decrease in labour intensity, and improved cost-effectiveness. Understanding barriers to interest in ICBT is beneficial to effectively inform policy with regards to expanding this innovative therapeutic approach. To our knowledge no research has been conducted to look at the relationship between barriers and interest in ICBT. The objective of this study was to understand associations between common attitudinal and structural barriers, and ICBT-specific barriers on interest in ICBT as well as to understand direct and mediating association of barriers with interest in ICBT. This cross-sectional observational study was conducted among adult (>18 years) urban and rural residents (n=200) in Saskatchewan, Canada. Data were collected through an online survey that contained 27 constructs measuring barriers and interest in ICBT. Multivariable linear regression analyses were conducted with interest in ICBT as the dependent variable and barriers as independent variables after controlling for age, gender, residency (urban/rural), and depression or generalized anxiety symptoms. Utilizing structural equation modeling, a path analysis framework was developed by incorporating previously established associations from multivariable regression analyses to model direct and indirect associations through path analysis. The path analysis framework showed that perceived access to care played a mediating role in mitigating the negative association of life chaos and financial concerns on interest in ICBT. Similarly, computer self-efficacy was a significant mediator in negative association of computer anxiety on interest in ICBT. In the context of the framework, significant direct effect on interest in ICBT held to be true for observed attitudinal barriers: self-stigma of seeking help and perceived need for help. The findings of this study pointed towards several policy implications, including aligning ICBT towards communities with lower access to care and higher need for intervention. To our knowledge, this study is the first to empirically show direct and indirect associations of barriers with interest in ICBT utilizing path analysis. In informing health care policy decisions, path analysis could be a useful technique in analyzing complex relationships and prioritize intervention factors, an approach which would not be possible to implement using traditional regressions analyses.
Open Access
Exploring Social Learning in Yorkton Following the 2010, 2014 and 2016 Floods
(Faculty of Graduate Studies and Research, University of Regina, 2021-06) Salman, Alida; Hurlbert, Margot; Dupeyron, Bruno; Warren, James; Mou, Haizhen; Dolter, Brett
The objective of this study is to explore whether social learning has occurred in Yorkton following the flood events that the City experienced in 2010, 2014 and 2016. The study also aims to understand the factors that impacted social learning’s occurrence, its interrelation with the window of opportunity, and the outcomes that it produced. The data for this study came from 15 semi-structured interviews and 110 newspaper articles on the flood events and the infrastructure upgrades. The data showed that the flood experience and the interactions and communications between the City, the Council and the public have produced social learning. However, this learning has been mainly single-loop learning, with some indicators exhibiting double loop learning. While the data revealed no explicit barriers to social learning, the perception that the public cannot contribute to stormwater management issues may have inhibited the degree of social learning that was achieved in Yorkton. In addition, the 2010 flood opened a window of opportunity for change, allowing the City and the Council to introduce a number of expensive upgrades. The subsequent floods contributed to keeping the window open. Furthermore, the data showed that social learning and the window of opportunity are interrelated. As a result of social learning and the policy window that opened after the flood, Yorkton is now more prepared to deal with future events, both in terms of prevention as well as emergency response. However, it was found that social learning is diminishing as a result of the passage of time and the false sense of safety that the infrastructure upgrades created. The diminishing of social learning has policy implications for Yorkton as the city has not yet implemented all the proposed upgrades.
Open Access
Land of the Living Political Skies: Perspectives on the 2016 Election
(Johnson Shoyama Graduate School of Public Policy, 2016-04-05) Béland, Daniel; Farney, Jim; McIntosh, Tom; Mou, Haizhen
Open Access
Policy priorities for aging adults with autism: Perspectives of personal support persons
(Faculty of Graduate Studies and Research, University of Regina, 2024-12) Anaba, Cynthia Lamisi; Zarzeczny, Amy; Mou, Haizhen; Mahani, Akram
Background: The field of aging with autism spectrum disorder is a rapidly growing area of research. Experts are increasingly focused on understanding the unique challenges faced by adults on the spectrum as they navigate aging. The challenges include aspects like maintaining independence, managing sensory sensitivities, and navigating potential changes in cognitive function. While these challenges are real, there is also a tremendous opportunity to discover and implement effective support systems. By learning more about the specific needs of adults with autism, we can develop targeted interventions and resources that empower them to thrive throughout their lives. This could encompass everything from social connection programs to sensory-sensitive housing options, and tailored healthcare plans. However, current literature highlights a significant knowledge gap in healthy aging among adults with autism. Objective: This study aims to help fill this gap by exploring the perspectives of personal support persons (family, friends, caregivers) regarding what policy priorities are important to support aging well for adults with autism. Methods: Using a qualitative semi-structured interview approach, the study explored the experiences, concerns, and priorities of personal support persons, aiming to identify policy gaps and opportunities for improving healthy aging within this under-researched group in the province of Saskatchewan. Results: The personal support persons interviewed in this study discussed challenges that the adults with autism they support face upon entering adulthood, especially in areas like employment, housing, transportation, and healthcare in the province of Saskatchewan. The study's results highlight key themes identified through participant interviews, analyzed within Sen's capability approach framework. This framework focused on capabilities (what a person can do), opportunities (resources available to the person), and freedom (choice and control) as crucial elements in understanding policy priorities to support the healthy aging of adults with autism. By examining these themes, the study underscored the need to move beyond mere service provision to empower individuals and advocate for inclusive policies. This study produced insights into how to better support adults with autism. This study found a need for tailored interventions, continuous and timely accessible support services, and policy changes that promote social inclusion. Conclusion: Using the capability approach, this research suggests specific recommendations such as improved support service navigation, social inclusion programs, retirement planning, and tailored insurance plans. Overall, this approach emphasizes a comprehensive strategy to create a more supportive environment for adults with autism to age well. Key Words – healthy aging, adults with autism, personal support persons, Sen's capability approach
Open Access
Population Aging and Long-Term Care Policy Change in Canada: A Comparison of British Columbia, Manitoba, and Ontario
(Faculty of Graduate Studies and Research, University of Regina, 2014-11) Harris, Jonathan Brody; Marchildon, Gregory; Zarzeczny, Amy; Mou, Haizhen; Genoe, Rebecca
Introduction: Residential long-term care (LTC) is an important component of the care continuum for older adults in Canada. Three factors related to population aging are contributing to an increased demand for LTC services: 1) an increased prevalence of age-related health disorders; 2) reduced societal capacity to provide unpaid care; and 3) a lack of available substitutes for LTC. LTC is not one of Medicare’s insured services and as such great variation in the provision of LTC services exists across provinces. Provincial governments are currently grappling with how best to provide and pay for quality LTC services while also weighing investment in other aspects of the care continuum to delay or prevent LTC admission. Purpose: The purpose of this thesis is to examine LTC policy changes since 1990 and the impact these have had on LTC spending and quality in three provinces that represent natural policy experiments: British Columbia, where a disinvestment in LTC and concurrent investment in assisted living has taken place; Manitoba, one of the largest per capita spenders on both LTC and home care; and Ontario, which has essentially maintained the status quo. Methods: A retrospective comparative case study approach adapted from the work of Richard Rose (2005) is used to compare provincial experiences. Evidence was drawn from a comprehensive literature review of not only peer-reviewed literature but also grey literature, including policy and planning documents and advocacy group and think-tank reports. Descriptive analysis was performed on spending data obtained from the Canadian Institute for Health Information’s National Health Expenditures Database, and Quality data obtained from the Canadian Institute for Health Information’s Continuing Care Reporting System. Results: British Columbia’s strategy of investment in assisted living in lieu of LTC resulted in substantial cost savings since the early 2000s. LTC quality was best in Manitoba, where the per capita spend on LTC is highest, although resident populations varied slightly between provinces. Conclusions and Recommendations: While British Columbia has successfully reduced costs in the LTC sector by substituting assisted living, there is some evidence to suggest that this approach may create barriers to access and lead to downward pressures in other parts of the health system, particularly acute care. Investment in a robust continuum of care that includes support for informal carers, home care, respite care, assisted living, and LTC where appropriate seems the best way to meet the needs of the aging population while providing affordable and high quality LTC. Additionally, paradigms such as aging in place, although well-intentioned, may be misused by governments to achieve policy ends and can be a barrier to effective reform in the LTC sector. Keywords: Long-term care, continuing care, aging, health policy, health services.
Open Access
Preferences and experiences of interdisciplinary communication across hospital unit types: A survey of three health professions in a Regina, Saskatchewan hospital
(Faculty of Graduate Studies and Research, University of Regina, 2024-03) Morrissette, Alana Marie; Camillo, Cheryl; Zarzeczny, Amy; Mou, Haizhen
In the literature, interdisciplinary communication has been linked to high quality patient care, reduced medical error and improved patient and care provider satisfaction. Information sharing, role clarity, and shared goal setting amongst care providers are also attributed with interdisciplinary communication. The Accountable Care Unit (ACU) is an innovative, microsystem-based approach to inpatient hospital care that incorporates distinct features facilitating interdisciplinary collaboration and communication including: geographic co-location of a physicians’ patients and Structured Interdisciplinary Bedside Rounds (SIBR). During SIBR, care providers meet at the patient’s bedside and use a standardized communication protocol to provide and receive information. Traditional hospital wards, on the contrary, lack such features and intentional design. While existing research has separately explored outcomes of ACUs and aspects of interdisciplinary care, no known study has assessed healthcare providers experiences with interdisciplinary communication on ACUs versus traditional wards. The overarching purpose of this study was to understand perceived differences between interdisciplinary communication on traditional medicine wards and ACUs. The research questions that prompted this investigation included: 1. What are the experiences and perceptions of interdisciplinary communication on ACUs at the Pasqua Hospital by nurses, pharmacists and physicians who have previously worked on a traditional medicine ward? 2. How do participants perceive interdisciplinary communication on an ACU versus a traditional ward? 3.Do common themes emerge amongst research participants with similar demographics or professions? The first ACU in Canada was implemented in 2016 on unit 4A at the Pasqua Hospital in Regina, Saskatchewan to reduce lengths of stay, decrease mortality rates, and improving patient and staff satisfaction. In the following years, additional ACUs were implemented at the Pasqua Hospital and in other Saskatchewan hospitals. This research was carried out via an online survey that offered 9 demographic questions and 6 qualitative questions pertaining to interdisciplinary communication both generally, on ACUs, and on traditional wards. The survey was administered from July 13 2022 until October 31 2022 to physicians, pharmacists and nurses who volunteered to participate and who had work experience on both types of units. Fifteen respondents completed the survey and responses were analyzed using descriptive statistics and thematic analysis. Participants of this study reported an overall positive and enhanced experience with interdisciplinary communication on ACUs, generally finding it more effective than on traditional units. Reasons for this included structured communication amongst multiple care providers, regionalization of patients within the hospital with consistency in care providers, respect, and role clarity. Conversely, participants reported interdisciplinary communication to be more difficult on traditional units due to a lack of structure, absence or unavailability of team members, professional silos, hierarchies and egos. With the exception of respondents’ profession, correlations between demographic information, such as gender or age, and thematic codes proved to be inconclusive. The findings of this research could assist in guiding policies that adopt techniques or models, such as microsystem-based care models and scheduled, structured interdisciplinary rounds, which foster improved interdisciplinary communication and teamwork on acute care medicine wards. The implementation of such approaches could improve staff satisfaction, retention, and patient safety, while reducing liability risks and medical errors. Future researchers may consider investigating ACUs at other sites while acquiring more in-depth demographic information of increasingly diversified participants.
Open Access
The hidden triad of cannabis influence
(Faculty of Graduate Studies and Research, University of Regina, 2024-07) Bojkovsky, Cynthia Dawn; Dupeyron, Bruno; Zarzeczny, Amy; Camillo, Cheryl; Mou, Haizhen; Novotna, Gabriela; Bear, Daniel
Description of the Problem In October 2018, the Government of Canada became the second country in the world to legalize non-medical cannabis, with the goal to promote better health and well-being amongst Canadians. To date, the ways in which young adults in Canada perceive and experience cannabis in this new legal context have been minimally explored and are not well understood. This research contributes important insights into how young adults in Saskatchewan perceive and understand their own health and well-being in relation to cannabis in a context of legal non-medical use. These findings are relevant for future policy and program developments in this area. Methods The objective of this study was to answer the primary research question “How do young adults perceive and experience cannabis use, in particular from a health perspective, in the context of Canada’s current policy frameworks?” This study applies constructivist grounded theory data collection and analysis techniques, guided by the work of Kathy Charmaz (2014). Data was collected through 10 in-depth interviews with young adults in Saskatchewan. The information was transcribed and thoroughly analyzed to transition from analytical findings to theoretical understanding. Secondary research questions addressed the relationship between cannabis related perceptions and experiences, influences shaping those perceptions and experiences, and the policy implications. Findings The main outcome from this study is entitled “The Hidden Triad of Cannabis Influence”, a grounded theory that explains how young adults perceive and experience cannabis within a legal non-medical and medical cannabis policy framework and an illicit market. Although the young adults who participated in this research tended not to outwardly identify policy and market factors as influencing their health and well-being, this theory substantiates the presence of these influences. The four main policy considerations emerging from this study include: • evaluate the short-term outcomes of non-medical cannabis legalization, including but not limited to input from young adults and qualitative research findings • develop a robust health literacy approach to promote public health objectives related to non- medical and medical cannabis use by young adults • improve supports in the health care system for medical use and misuse of cannabis to promote harm reduction • take additional measures to mitigate the illicit market for cannabis The results of this study offer preliminary evidence about how young adults perceive and experience their own health and well-being within a context of legal non-medical cannabis. Keywords Cannabis; marijuana; legalization; young adults; grounded theory; health policy; perceptions
Open Access
The Post-Pandemic Economy: What do Canadians Want?
(2021-03-17) Atkinson, Michael; Mou, Haizhen
This issue of JSGS Policy Brief is part of a series dedicated to exploring and providing evidence-based analysis, policy ideas, recommendations and research conclusions on the various dimensions of the pandemic, as it relates here in Canada and internationally.
Open Access
Western Policy Analyst Quarterly Volume 2 Issue 3
(2011-09) Mou, Haizhen; Marshall, Jim; Zhang, Lihui; Olfert, Rose
The Public-Private Mix of Health Care Spending – 1; Pension Membership – 4; Internet Access – 6; Trends in the Western Labour Force – 8
Open Access
Western Policy Analyst Quarterly Volume 4 Issue 2
(2012-12) Wilson, Stuart J.; Olfert, M. Rose; Marchildon, Gregory P.; Mou, Haizhen; Harris, Jonathan; Lockhart, Wallace; Zhang, Lihui
Resource Revenues and Heritage Funds – 1; Employment Options for On-Reserve Populations – 4; What does the New Canada Health Transfer Plan mean for Western Canada? – 7; Out-of-pocket Prescription Drug Cost – 10