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During the COVID-19 pandemic, the limited in-person availability of oral health care providers resulted in an unprecedented utilization of the teledentistry tool. This paper reviews how Canadian organizations supported teledentistry and what can be expected about its usage in the post-pandemic era. An environmental scan across relevant Canadian federal, provincial, and territorial organizations was conducted to review pertinent publicly available documents, including dental regulators’ or associations’ COVID-19 guidance documents, government documents, and media articles. Almost all jurisdictions promoted teledentistry for triaging dental emergencies and screening patients for COVID-19 symptoms but not even half of them have developed guidelines in terms of modalities of usage, handling of personal information, informed consent process, or maintaining standards of practice. During the COVID-19 recovery phase, these advances across Canada will support in developing a comprehensive guidance for teledentistry and possibly specific codes for its utilization. This can create a niche for teledentistry as an adjunct to the main stream dental care delivery where some visits can always be accommodated virtually, reducing disparities in oral healthcare between rural and urban communities. Ultimately, this can potentially make oral health care delivery more effective, efficient, and environmentally friendly in Canada.

IntroductionThe environmental scan has been described as an important tool to inform decision-making on policy, planning and programme development in the healthcare sector. Despite the wide adoption of environmental scans, there is no consensus on a working definition within the health services delivery context and methodological guidance on the design and implementation of this approach is lacking in the literature. The objectives of this study are to map the extent, range and nature of evidence that describe the definitions, characteristics, conceptualisations, theoretical underpinnings, study limitations and other features of the environmental scan in the health services delivery literature and to propose a working definition specific to this context.Methods and analysisThis protocol describes a scoping review based on the methodology outlined by Khalil and colleagues. A comprehensive search strategy was developed by experienced health science librarians in consultation with the research team. A Peer Review of Electronic Search Strategies (PRESS) was completed. Two reviewers will independently screen titles, abstracts and full-text articles and select studies meeting the inclusion criteria from seven electronic databases: Academic Search Premier, Canadian Business & Current Affairs (CBCA), CINAHL, ERIC, Embase, MEDLINE and PsycINFO. The grey literature and reference lists of included articles will also be searched. The data will be analysed and presented in tabular format, and will include a descriptive numerical summary as well as a qualitative thematic analysis.Ethics and disseminationThis protocol provides an audit trail for a scoping review that will advance understanding about the environmental scan and its application in the health services delivery context. The review will propose a working definition and will inform future research to explore the development of a conceptual framework in this context. Findings will be disseminated through a peer-reviewed journal and conference presentations. The scoping review does not require ethics approval.

Background Despite the high prevalence of alcohol use and marketing in many settings across sub-Saharan Africa, few studies have systematically sought to assess alcohol marketing exposure, particularly in vulnerable areas such as urban slums where alcohol is often highly prevalent but where educational programs and alcohol prevention messages are scarce. Objective To pilot test the development and implementation of environmental scans of alcohol advertisements in five urban slums across different areas of Kampala, Uganda: Bwaise, Kamwokya, Makindye, Nakulabye, and Nateete. Methods Each of the five scans was conducted in geographical circles, within a 500-m radius of a Uganda Youth Development Link (UYDEL) drop-in Center using a container-based approach. Using a Garmin GPS with photo capabilities and a tablet for data entry, teams of at least two trained researchers walked the main roads within the target area and gathered information about each alcohol advertisement including its location, type, size, and placement and other characteristics. Data with the GPS coordinates, photos and descriptive details of the adverts were merged for analyses. Results A total of 235 alcohol adverts were found across all five data collection sites reflecting 32 different brands. The majority of the adverts (85.8%) were smaller and medium sizes placed by restaurants and bars, stores and kiosks, and liquor stores. The most frequently noted types of alcohol in the adverts were spirits (50.6%) and beer (30.6%). Recommendations The pilot test of the methodology we developed indicated that implementation was feasible, although challenges were noted. Since monitoring alcohol marketing is key for addressing underage alcohol use and harm, the advantages and disadvantages of the approach we developed are discussed. Future research needs to strengthen and simplify strategies for monitoring alcohol marketing in low-resource settings such as urban slums which have unique features that need to be considered. Meanwhile, the findings may yield valuable information for stakeholders and to guide intervention developments and alcohol marketing policy to protect youth.

Background Surf lifesavers are volunteer first responders across Australian waterways, performing coastal rescues, and other high-risk activities. Personnel undertaking these activities can include young people, from age 13. The mental health impact of these activities, and of strategies to improve wellbeing, is not well understood. Young surf lifesavers (aged 13–25) are known to be a cohort particularly vulnerable to mental health challenges associated with these tasks. This study aims to assess existing mental health toolkits available online in Australia and New Zealand, in relation to their relevance to this group with the goal of guiding the creation of a helpful, engaging toolkit for this demographic. Methods Using an environmental scan methodology, we examined 32 mental health toolkits available online which focus on improving wellbeing. Expert assessments of these tools were undertaken from researcher, psychological, social work, Surf Life Saving Australia (SLSA), and non-SLSA first respondent perspectives to ascertain their relevance for young lifesavers, in accordance with the duties they undertake. Toolkits were scored on their usefulness, relevance, appropriateness, accessibility, and efficacy in addressing general trauma and trauma specific to SLSA duties. Results Toolkits were reviewed by 68 experts across several domains. Toolkits intended for first responders and young people scored highest across all variables, while qualitative feedback emphasised strategies to adapt existing toolkits for the target audience either stylistically and tonally or in terms of content or supplementary mental health interventions. No existing toolkit directly targeted experiences associated with the general tasks involved in surf lifesaving. This environmental scan reveals gaps where bespoke mental health toolkits could focus, for instance on the impact of performing rescues and other high-risk situations, such as responding to suicides and self-harm, that arise in Australian waterways; as well as emphasising the value of the SLSA community as a potential protective factor mitigating trauma exposure. Conclusions Further work should be undertaken with intended toolkit end users to develop fit-for-purpose resources within a psychosocially supportive context, working with the strengths of young SLSA members.

Human papillomavirus (HPV) causes over 39,000 cancers annually in the US. The HPV vaccine is safe and effective but underutilized to prevent cancer. In the US, only 37% of adolescents ages 13–17 have received the full vaccine series. Ineffective messages and misinformation about the vaccine have negatively impacted its uptake in the US. It was initially only approved for girls and early marketing focused on cervical cancer prevention and prevention of HPV as a sexually transmitted infection. Understanding effective messages and methods of dissemination is critical to address suboptimal vaccine uptake. Qualitative interviews were conducted with 34 participants to identify best practices for HPV vaccination messaging in SC. Participants included state leaders representing public health, medical associations, K-12 public schools, universities, insurers, and cancer advocacy organizations. Recommended HPV vaccine messages included focusing on cancer prevention rather than sexual transmission, routinizing the vaccine, and highlighting risks/costs of HPV. Targeting messages to specific demographics and utilizing multiple media platforms to disseminate consistent, scientifically accurate messages were recommended. Strategies such as appealing to parents’ moral responsibility to protect their children against cancer and addressing the ubiquity of HPV and sharing growing evidence that HPV may be transmitted independent of sexual activity were also recommended. Suggested HPV vaccine messengers included trusted peers, medical professionals, and health associations. Culture-centered narratives to raise the voices of cancer survivors and parents were also recommended. This study provides an array of HPV vaccination messages and dissemination strategies for optimizing HPV vaccination rates.

Infant prematurity, low birth weight, and critical illness often require neonatal intensive care unit (NICU) admission. Although beneficial, hospitalization may interrupt the usual processes through which infants receive vaccines in the community. To mitigate potential disruptions to scheduled vaccinations, an infant's NICU stay may be an opportunity for timely vaccine delivery. The frequency and nature of these practices are known to vary across Canada. This study aimed to determine what vaccination policies, practices, and procedures exist in Canadian Level-III NICUs. A pan-Canadian environmental scan was conducted from May to October 2023 to identify vaccine policies, practices, and procedures from Level-III NICUs. Data collection included an internet search and email consultation with NICU professionals (i.e., nurses, physicians, etc.). Information was synthesized to identify the commonalities and differences between vaccination practices across Canada. Twenty-one (out of 32 contacted) Level-III NICUs responded, with all respondents (21/21) confirming that their NICU provided selected routine vaccinations and respiratory syncytial virus (RSV) prophylaxis to admitted infants. NICU nurses (21/21) were the main vaccine provider, with hospitals in one province augmenting delivery with public health nurses (3/21). Only 8/21 NICUs reported delivering rotavirus vaccines prior to discharge. Across Canada, all surveyed Level-III NICUs reported delivering some routine vaccinations, indicating an effort to optimize vaccine uptake during hospitalization. There were variations in the specific vaccines (e.g. rotavirus vaccines) provided. Understanding where and why these variations exist is crucial for informing and enhancing evidence-informed NICU vaccination programs nationwide. •All Level-III NICUs surveyed administered routine vaccines during admission.•Wide variation in rotavirus use and delivery models highlights practice gaps.•Standardized NICU vaccine protocols could reduce missed immunization opportunities.

In the past, neurorehabilitation for individuals with neurological damage, such as spinal cord injury (SCI), was focused on learning compensatory movements to regain function. Presently, the focus of neurorehabilitation has shifted to functional neurorecovery, or the restoration of function through repetitive movement training of the affected limbs. Technologies, such as robotic devices and electrical stimulation, are being developed to facilitate repetitive motor training; however, their implementation into mainstream clinical practice has not been realized. In this commentary, we examined how current SCI rehabilitation research aligns with the potential for clinical implementation. We completed an environmental scan of studies in progress that investigate a physical intervention promoting functional neurorecovery. We identified emerging interventions among the SCI population, and evaluated the strengths and gaps of the current direction of SCI rehabilitation research. Seventy-three study postings were retrieved through website and database searching. Study objectives, outcome measures, participant characteristics and the mode(s) of intervention being studied were extracted from the postings. The FAME ( F easibility, A ppropriateness, M eaningfulness, E ffectiveness, E conomic E vidence) Framework was used to evaluate the strengths and gaps of the research with respect to likelihood of clinical implementation. Strengths included aspects of F easibility, as the research was practical, aspects of A ppropriateness as the research aligned with current scientific literature on motor learning, and E ffectiveness, as all trials aimed to evaluate the effect of an intervention on a clinical outcome. Aspects of F easibility were also identified as a gap; with two thirds of the studies examining emerging technologies, the likelihood of successful clinical implementation was questionable. As the interventions being studied may not align with the preferences of clinicians and priorities of patients, the A ppropriateness of these interventions for the current health care environment was questioned. M eaningfulness and E conomic E vidence were also identified as gaps since few studies included measures reflecting the perceptions of the participants or economic factors, respectively. The identified gaps will likely impede the clinical uptake of many of the interventions currently being studied. Future research may lessen these gaps through a staged approach to the consideration of the FAME elements as novel interventions and technologies are developed, evaluated and implemented.

Purpose - Organizational change is a risky endeavour. Most change initiatives fall short on their goals and produce high opportunity and process costs, which at times outweigh the content benefits of organizational change. This paper seeks to develop a framework, offering a theoretical toolbox to analyze context-dependent barriers and enablers of organizational change. Starting from an organizational identity perspective, it aims to link contingency-based approaches, such as environmental scan, SWOT and stakeholder analysis, with insights from organizational behaviour research, such as knowledge sharing and leadership.Design methodology approach - The framework is informed by long-lasting field research into organizational change in an international policing environment. The theories in the framework are selected from the perspective of field validity in two ways; they were chosen because the topics covered by these theories emerged as relevant during the field research and therefore it can be expected they have applicability to the field. The authors' insights and suggestions are summarised in 13 propositions throughout the text.Findings - The analysis provides a clear warning that organizational change is more risky and multifaceted than change initiators typically assume. It is stressed that the external environment and the internal dynamics of organizations co-determine the meaning of managerial practices. This implies that cure-all recipes to organizational change are bound to fail.Originality value - This paper makes an ambitious attempt to cross disciplinary boundaries in the field of organizational change research to contribute to a more comprehensive and holistic understanding of change processes by integrating perspectives that focus on the internal context and the external environment of organizations.

Background Improving access to primary healthcare (PHC) for vulnerable populations is important for achieving health equity, yet this remains challenging. Evidence of effective interventions is rather limited and fragmented. We need to identify innovative ways to improve access to PHC for vulnerable populations, and to clarify which elements of health systems, organisations or services (supply-side dimensions of access) and abilities of patients or populations (demand-side dimensions of access) need to be strengthened to achieve transformative change. The work reported here was conducted as part of IMPACT (Innovative Models Promoting Access-to-Care Transformation), a 5-year Canadian-Australian research program aiming to identify, implement and trial best practice interventions to improve access to PHC for vulnerable populations. We undertook an environmental scan as a broad screening approach to identify the breadth of current innovations from the field. Methods We distributed a brief online survey to an international audience of PHC researchers, practitioners, policy makers and stakeholders using a combined email and social media approach. Respondents were invited to describe a program, service, approach or model of care that they considered innovative in helping vulnerable populations to get access to PHC. We used descriptive statistics to characterise the innovations and conducted a qualitative framework analysis to further examine the text describing each innovation. Results Seven hundred forty-four responses were recorded over a 6-week period. 240 unique examples of innovations originating from 14 countries were described, the majority from Canada and Australia. Most interventions targeted a diversity of population groups, were government funded and delivered in a community health, General Practice or outreach clinic setting. Interventions were mainly focused on the health sector and directed at organisational and/or system level determinants of access (supply-side). Few innovations were developed to enhance patients’ or populations’ abilities to access services (demand-side), and rarely did initiatives target both supply- and demand-side determinants of access. Conclusions A wide range of innovations improving access to PHC were identified. The access framework was useful in uncovering the disparity between supply- and demand-side dimensions and pinpointing areas which could benefit from further attention to close the equity gap for vulnerable populations in accessing PHC services that correspond to their needs.

There is increasing interest in shared decision making (SDM) in Australia. Question prompt lists (QPLs) support question asking by patients, a key part of SDM. QPLs have been studied in a variety of settings, and increasingly the internet provides a source of suggested questions for patients. Environmental scans have been shown to be useful in assessing the availability and quality of online SDM tools. This study aimed to assess the number and readability of QPLs available to users via Google.com.au. Our environmental scan used search terms derived from literature and reputable websites to search for QPLs available via Google.com.au. Following removal of duplicates from the 4000 URLs and 22 reputable sites, inclusion and exclusion criteria were applied to create a list of unique QPLs. A sample of 20 QPLs was further assessed for list length, proxy measures of quality such as a date of review, and evidence of doctor endorsement. Readability of the sample QPL instructions and QPLs themselves was assessed using Flesch Reading Ease and Flesch-Kincaid Grade Level scores. Our environmental scan identified 173 unique QPLs available to users. Lists ranged in length from 1 question to >200 questions. Of our sample, 50% (10/20) had a listed date of creation or update, and 60% (12/20) had evidence of authorship or source. Flesch-Kincaid Grade Level scores for instructions were higher than for the QPLs (grades 10.3 and 7.7, respectively). There was over a 1 grade difference between QPLs from reputable sites compared with other sites (grades 4.2 and 5.4, respectively). People seeking questions to ask their doctor using Google.com.au encounter a vast number of question lists that they can use to prepare for consultations with their doctors. Markers of the quality or usefulness of various types of online QPLs, either surrogate or direct, have not yet been established, which makes it difficult to assess the value of the abundance of lists. Doctor endorsement of question asking has previously been shown to be an important factor in the effectiveness of QPLs, but information regarding this is not readily available online. Whether these diverse QPLs are endorsed by medical practitioners warrants further investigation.