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ObjectiveThe objective is to describe the experiences and perceptions of caregivers who participated in a community systems navigator intervention that addressed unmet social needs.Design, setting and patientsA qualitative descriptive study with caregivers of children enrolled in a clinical trial addressing unmet social needs of families with children cared for in a tertiary pediatric weight management clinic, through community systems navigation. Participants were asked open-ended questions related to perceptions of social needs screening in clinical settings. Interviews were recorded and analysed using Braun and Clarke’s six-phase approach to thematic analysis.ResultsTen parent participants were interviewed. Social needs screening perception and acceptability varied between participants. Social needs screening was comfortable for most but stressful for others. Participants noted that trusting relationships promote comfort with sharing social needs information, and this data should be shared on the electronic health record if accurate and purposeful. They found the online screening tool convenient but thought it could also limit opportunities to elaborate. Some participants noted the intervention of community systems navigation helpful; however, others described the need for more tailored resources.ConclusionsScreening for unmet social needs in clinical settings is complex and should be family centred, including the consideration of the mode of screening, data sharing in the electronic health record and ensuing interventions. Perspectives of families should drive the design of future larger scale community navigation interventions to address unmet social needs in clinical settings.

Background The burden of childhood obesity and cardiometabolic risk factors affecting newcomer Canadians living in lower socioeconomic circumstances is a concerning public health issue. This paper describes Strengthening Community Roots: Anchoring Newcomers in Wellness and Sustainability (SCORE!), an academic-community research partnership to co-design interventions that nurture and optimize healthy activity living (HAL) among a community of children and families new to Canada in Hamilton, Ontario, Canada. Methods/Design Our overarching program is informed by a socio-ecological model, and will co-create HAL interventions for children and families new to Canada rooted in outdoor, nature-based physical activity. We will proceed in three phases: Phase 1) synthesis of existing evidence regarding nature based HAL interventions among children and families; Phase 2) program development through four data collection activities including: i) community engagement activities to build trustful relationships and understand barriers and facilitators, including establishing a community advisory and action board, qualitative studies including a photovoice study, and co-design workshops to develop programs; ii) characterizing the demographics of the community through a household survey; iii) characterizing the built environment and HAL programs/services available in the community by developing an accessible real-time systems map; and iv) reviewing municipal policies relevant to HAL and sustainability; leading to Phase 3) implementation and evaluation of the feasibility of co-designed HAL programs. Conclusion The etiology of childhood obesity and related chronic diseases is complex and multifactorial, as are intervention strategies. The SCORE! program of research brings together partners including community members, service providers, academic researchers, and organizational leaders to build a multi-component intervention that promotes the health and wellness of newcomer children and families.

ObjectivesThe study objective was to understand the barriers and facilitators to healthy active living in South Asian families living in Canada.DesignSemi-structured interviews of 30–60-minute duration with South Asian women with young families, and analysed using a thematic analytical approach.SettingCommunity-dwelling South Asian women interviewed in the home environment or by phone.ParticipantsFifteen married South Asian women (mean age=34.2 years) living in the Peel region of Ontario, Canada, with at least 1 child under the age of 5 years. The majority of women had immigrated to Canada (13/15), during a 5–10-year interval preceding interviews.Results57 different codes were derived from 18 interview hours, and further evaluated through member checking. The top three barriers to healthy eating were: (1) not having enough time for healthy food preparation, (2) lack of knowledge about what is healthy eating and (3) viewing healthy eating as a matter of engaging in time limited dieting. These barriers were addressed with: (1) knowledge and awareness of healthy eating, (2) clear goal setting, (3) access to fresh vegetables and fruits and (4) better arrangements and more time for food preparation. The top five barriers to physical activity were: (1) not enough time and energy, (2) competing priorities, (3) lack of childcare, (4) lack of family-engaging exercise and (5) limited access to interesting exercise programming. These barriers were addressed by: (1) experiencing exercise as enjoyable and stress releasing, (2) commitments to walking exercise, (3) use of an electronic exercise-tracking device, (4) offspring exercise supported by spouse and family and (5) success stories about exercise from others.ConclusionsBarriers to healthy active living in South Asian women with young families can be addressed with facilitators that stimulate clear goal setting and healthy food preparation skills, and exercise formats that engage mothers and offspring, with or without exercise tracking.

ObjectivesTo evaluate the association between corticosteroid use and clinical outcomes in children hospitalised with severe orbital infections, and to describe practice patterns of systemic corticosteroid use.DesignMulti-site observational cohort study using hospital data from 2009 to 2018.SettingCanadian children’s hospitals (7) and community hospitals (3).PatientsChildren 2 months and 18 years hospitalised with severe orbital infections.InterventionsSystemic corticosteroids at any timeMain outcome measuresLength of hospital stay and surgical intervention using time-to-event Cox proportional hazards multivariable regression models to account for potential differences in timing of corticosteroid use (early, ≤24 hours or late, >24 hours after admission), with adjustment for covariates.ResultsOf the 1479 hospitalised children, 876 (59.2%) were male and median age was 5.3 years (IQR 2.2 to 9.8). Of the 65 (4.4%) who received corticosteroids, over half (53.8%) received them early. Median length of stay was 75.9 hours (IQR 47.1 to 130.4) and 98 (6.6%) underwent surgical intervention. Corticosteroid use was associated with delayed discharge and prolonged hospitalisation, as reflected by a HR of 0.73 (95% CI 0.55 to 0.96) in adjusted analyses. However, systemic corticosteroids had no association with surgical intervention (HR 0.82, 95% CI 0.36 to 1.88).ConclusionIn a large cohort of hospitalised children with severe orbital infections, corticosteroids were used infrequently, and when used, were not associated with improved clinical outcomes. Further high-quality trial evidence is needed to determine if routine corticosteroids are safe and effective.

ObjectivesIn the first full year of the COVID-19 pandemic (2020), South Asians living in the Greater Toronto and Hamilton Area (GTHA) and Greater Vancouver area (GVA) experienced specific barriers to accessing SARS-CoV-2 testing and reliable health information. However, between June 2021 and February 2022, the proportion of people having received at least one COVID-19 vaccine dose was higher among this group (96%) than among individuals who were not visible minorities (93%). A better understanding of successful approaches and the challenges experienced by those who remain unvaccinated among this highly vaccinated group may improve public health outreach in subsequent waves of the current pandemic or for future pandemic planning. Using qualitative methods, we sought to explore the perceptions of COVID-19 risk, vaccine access, uptake and confidence among South Asians living in Canada.DesignSemistructured interviews conducted with 25 participants analysed using thematic analysis. Throughout this process, we held frequent discussions with members of the study’s advisory group to guide data collection (community engagement, recruitment and data analysis).SettingCommunities of the GTHA and GVA with interviews conducted virtually over Zoom or telephone.Participants25 participants (15 from Ontario and 10 from British Columbia) were interviewed between July 2021 and January 2022. 10 individuals were community members, 9 were advocacy group leaders and 6 were public health staff.ResultsAccess to and confidence in the COVID-19 vaccine was impacted by individual risk perceptions; sources of trusted information (ethnic and non-ethnic); impact of COVID-19 and the pandemic on individuals, families and society; and experiences with COVID-19 mandates and policies (including temporal and generational differences). Approaches that include community-level awareness and tailored outreach (language and cultural context) were considered successful.ConclusionsUnderstanding factors and developing strategies that build vaccine confidence and improve access can guide approaches that increase vaccine acceptance in the current and future pandemics.Visual abstract can be found at https://drive.google.com/file/d/1iXdnJj9ssc3hXCllZxP0QA9DhHH-7uwB/view

IntroductionWhile health research about persons of South Asian ancestry has been conducted for decades in Canada, it often uses pathologising approaches that fail to consider historical, social and political factors shaping health disparities. Further, this research rarely engages South Asian communities in meaningful ways, reinforcing feelings of disconnect and longstanding mistrust. Greater collaboration and transparency are needed to build trust and generate credible findings. The aims of this research protocol are to (1) examine how community engagement has been implemented in health research involving South Asian populations, (2) explore the experiences of both South Asian community members and academics involved in community-engaged research and (3) develop a framework guiding health research with and for South Asian communities in Canada, titled PRinciples to Operationalize Community Engagement, Equity, and Sustainability in South Asian Health Research in Canada (PROCESS).Methods and analysisThis ongoing codesigned concurrent multimethods study is being conducted with community partners across Canadian provinces. First, the scoping review is examining how community engagement has been operationalised in health research involving South Asian populations in Canada. We are performing a search in Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Web of Science, Scopus and PsycINFO databases for articles published between 2003 and 2024 referring to the concept of community engagement in South Asian health research. Two reviewers are independently completing abstract and full-text reviews based on preselected eligibility criteria. Data are being extracted from peer-reviewed studies using a data extraction framework. Findings will be aggregated and synthesised using descriptive content analyses. Second, a qualitative descriptive study is being conducted to explore the experiences of diverse stakeholders, including academics and community partners who are partaking in academic health research focused on South Asians. Semistructured interviews are being analysed using an inductive thematic content analysis. Results from the scoping review and qualitative interviews will be triangulated to detect emerging themes and patterns, which will enable the identification of principles to be incorporated within a draft of the PROCESS framework. In the final phase, we will use a modified Delphi process to iteratively codevelop the PROCESS framework with community partners and researchers across Canada.Ethics and disseminationThe Faculty of Medicine and Health Sciences Institutional Review Board at McGill University approved the study’s protocol (24-05-080). Results will be submitted for publication in peer-reviewed journals and presented in academic and community forums. Results will also be shared with diverse audiences across Canada through multiple formats, including articles, conferences, infographics and social media, with the aim of raising awareness and promoting the adoption of research principles and practices for engaging South Asian communities in health research. This research received funding from the Canadian Institutes of Health Research (Grant #507768).

Background Gestational diabetes (GDM) confers an increased risk of future type-2 diabetes (T2D). We aimed to identify determinants of the progression of GDM to T2D in South Asian women and develop a precision prognostics model for potential future clinical application. Methods This study included 247 South Asian women with GDM from the prospective South Asian Birth Cohort (START) study in Ontario, Canada. Metabolomics was performed on 2nd trimester fasting serum samples by multisegment injection−capillary electrophoresis−mass spectrometry. We determined incidence of postpartum T2D through validated diagnostic codes using health administrative data. We used multivariable logistic regression to identify predictors of incident T2D through backward elimination. We assessed diagnostic performance of models using area under the receiver operating characteristic curve (AUC ROC) and 5-fold cross-validation to assess model stability. Results Of 247 South Asian women diagnosed with GDM with a mean age of 30.9 years and median total follow-up of 9.7 years, 45 (18.2%) developed T2D within a median of 4.9 years. Pre-pregnancy body mass index, area-under-the-curve glucose, and level of education, were identified as the strongest determinants of T2D post-GDM (AUC ROC = 0.83 [95% Confidence Intervals (CI), 0.78–0.88]). Addition of metabolite biomarkers—specifically, the hypoxanthine-to-creatinine ratio—only modestly improved predictive performance (AUC ROC = 0.853 [CI, 0.80–0.91]). Folds mean (SD) of the AUC ROC from 5-fold cross-validation models was 0.81 (0.12). Conclusions We developed a parsimonious five-factor model combining clinical, anthropometric, and metabolic markers that accurately predicts T2D progression after GDM in South Asian women. This model can be potentially deployed at the time of GDM diagnosis to improve risk assessment and target intensive postpartum interventions. Graphical Abstract

Background Perinatal health-seeking behaviours are influenced by various factors, including personal beliefs. South Asian women, who often live within a wide kinship system, can be influenced by the advice and guidance of their mothers and/or mothers-in-law. Methods To explore the cultural health perceptions of South Asian grandmothers within this context, we used constructivist grounded theory to sample and interview 17 South Asian grandmothers who reside in Southern Ontario, Canada. Interviews were audio-recorded, transcribed verbatim, and coded/analyzed by three independent coders. Results Many grandmothers emphasized that the preconception phase should focus on building healthy habits around nutrition, physical activity, and mental wellness; the pregnancy period should encompass an enriched environment (positive relationships, healthy routines, nutritional enhancement); and the postpartum phase should emphasize healing and restoration for both the mother and newborn (self-care, bonding, rebuilding healthy habits). Many of the grandmothers conceptualized these stages as a cyclical relationship where healing and restoration transitions gradually to re-establishing healthy habits before having a subsequent child. They also expressed responsibility in supporting their daughters and/or daughters-in-law with their family units and encouraging the transfer of perinatal health information. Conclusions South Asian grandmothers are involved in supporting the family units of their children and involving them in perinatal health programming can be an effective way to translate health knowledge to South Asian women. BQVYTXz1UENapzLR7eVasQ Video abstract. In order to impact a broad, diverse audience of community members, we collaborated with a South Asian film-maker to distil the research findings, write an impactful script, and produce a short digital story based on the research findings. Currently available on social media ( https://www.youtube.com/watch?v=tjcNUVOwatU ), the film was celebrated with a CIHR Institute for Human Development, Child and Youth Health Video Talks Prize in 2016.

Childhood obesity is a world-wide concern due to its growing prevalence and association with cardiometabolic risk factors in childhood and subsequent adult cardiovascular disease. In young pre-school children, there is uncertainty regarding which of the commonly used anthropometric measures of childhood obesity is best associated with cardiometabolic risk factors. This study compared the utility of common measures used in identifying obesity in these young children. The four commonly used metrics for identifying obesity in children: body fat percentage ≥ 90th percentile, waist circumference ≥ 90th percentile, BMI z score > 2 SD and waist-to-height ratio (WHtR) ≥ 0.5, were measured in a cohort of children born singleton, at full term and followed from birth (n = 761) to 5 years of age (n = 513). The utility of each in identifying cardiometabolic risk factors (fasting lipid profile, fasting blood glucose and blood pressure) was examined. At age 5 years, children with percent body fat ≥ 90th percentile or waist circumference ≥ 90th percentile, were associated with higher levels of triglycerides, glucose, and systolic and diastolic blood pressures than those < 90th percentile, respectively. Such differences were not obvious at age 3 years or at birth. A BMI z-score > 2 SD was associated with higher levels of triglycerides and systolic and diastolic blood pressure but not glucose at age 5 years. Differences in HDL cholesterol, fasting glucose and systolic blood pressure were observed in children with BMI z score > 2 SD at age 3 years but not with the other indices of obesity. As almost all children had WHtR ≥ 0.5 at birth, ages 1 and 3 years, this measure could not differentiate increased cardiometabolic risk. At age 5 years, the differences were much more obvious, with significant differences in triglycerides and systolic and diastolic blood pressures between those with WHtR ≥ 0.5 and those with < 0.5. Each of the four commonly used measures of childhood obesity shows moderate associations with cardiometabolic risk factors at 5 years, with no advantage of one measure over the other. These associations were less consistent at 3 years of age or younger. These observations have not been reported previously.

Background Childhood obesity is an ongoing public health crisis, and recent clinical practice guidelines identify addressing the role of social inequities in the disparity of health among children with obesity as an area to address. This study aimed to assess the feasibility of a community navigation intervention in a pediatric weight management clinic. Methods A single-center pilot randomized controlled trial (RCT) recruiting families from a tertiary hospital pediatric weight management program to evaluate the feasibility of a community navigation intervention. The primary feasibility outcomes were recruitment rates (goal to recruit 80% of the sample in 6 months), uptake of the intervention (goal > 80% of participants in the intervention group to have a visit with the navigator), and acceptability (goal > 90% of families in the intervention group complete all follow-up). Results Eighty participants completed the social needs screening, and 42 (52.5%) participants screened positive for an unmet social need. In the first 6 months of recruitment, 18 participants were recruited out of a goal of 40 participants (the recruitment rate was 45% vs. the goal of 80% in 6 months), and complete recruitment was achieved in 12 months. Of the 21 participants randomized to the intervention arm, 20 completed the intervention (uptake of intervention was 95% vs. goal 80%). Ten participants in the intervention arm completed all four planned follow-up study visits (the acceptability of follow-up was 48% vs. the goal of 90%). Conclusion We completed a pilot RCT of implementing a community navigator program in a pediatric weight management program. We found feasibility in the intervention’s uptake but limited feasibility in recruiting participants and the acceptability of the follow-up. Trial registration Clinicaltrials.gov, NCT04711707, https://clinicaltrials.gov/ct2/show/NCT04711707