韩国裸舞

A foundation of our Safe Birth in Cultural Safety project in Mexico, Nunavik and Montreal is the intergenerational bonds between traditional midwives and young women. Participatory research helped to pivot Western health care providers, spouses and families around this key strength, increasing cultural safety and safe birth in the terms set by traditional midwives.

Intergenerational learning played a key role in our approach to reproductive safety and prevention of gender violence in South Africa, Botswana, Nigeria, Pakistan, Mexico and with Indigenous Women鈥檚 Shelters in Canada. In southern Africa, we used radio-dramas to open the intergenerational dialogue; in Nigeria, we used video-dramas and, more recently, cellphilms.

Our Authentic Participatory Research with Older Adults for Cognitive Health (APROACH) pilot in Botswana and Montreal focuses on women as the overwhelming majority of people currently at risk of dementia and caring for those living with dementia. Intergenerationality energizes identification of achievable goals and collaboratively reaching them. Ripple effects include reduction of stigma related to dementia and its care, potentially contributing to a new paradigm of cognitive health with aging.

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One in every five people older than 64 years worldwide has mild cognitive impairment. One half of these will develop dementia within three years. Women are at a much higher dementia risk than men, even accounting for their living longer. Most people living with dementia do so in low- and middle-income countries (LMIC) yet investment in dementia prevention focuses on richer countries. Pharmaceutical solutions draw massive investment and great expectations. Drug costs are beyond the reach of most in rich countries, and likely everyone in LMIC, making access to prevention less equitable.

Clinical trials show addressing hypertension, diabetes, hearing and visual loss reduces dementia risk. This has been possible for many older adults in richer countries. In those places, dementia is decreasing. LMICs underinvest in health services, taking these simple solutions out of reach. We need prevention strategies that people can do themselves and that strengthen their communities. We need prevention that draws people into solving their own challenges. We need dementia prevention that works in richer and poorer countries.

Our solution looks beyond the medical condition of dementia. We revisit it in a framework of agency and active engagement of older adults at risk. Our solution replaces clinical approaches and patient roles with egalitarian and authentic participation. The process starts identifying known causes: hypertension, diabetes, loss of hearing and vision. With this in hand, a six-step protocol helps those at risk to work through their options. While doing so, they address the medical issues and vulnerable living conditions. First, each older adult depicts their priority issue. Arts-based methods level the playing field for those with language, hearing/visual problems. We then convene peer groups with shared interests. Group analysis of the evidence clarifies their options. Next, the group co-designs solutions/actions. This draws caregivers, service providers, family and neighbours into the process. Finally, the group evaluates how they changed their own health risks. They select another issue, depict it using arts-based methods, and repeat the process.

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Shared decision-making improves patient outcomes in family medicine by improving understanding of treatment options, risks, and benefits. It leads to better adherence to treatment plans, improved management of chronic conditions, and increased patient satisfaction. However, not all shared decision-making improves patient outcomes. Disparities in shared decision-making also affect more marginalized patients who feel disempowered to act. The last decade has seen a massive increase in application and reports of shared decision-making in family medicine, yet the field is under-theorized, the mechanisms for improving health outcomes poorly understood.

Our program involves a collaboration between Drs Roland Grad, Neil Andersson, Iv谩n Sarmiento and Anne Cockcroft to explore how shared decision-making happens in family medicine and what the dynamics of authentic participation can contribute to this. The output will generate middle-range theories on how participatory research works, for whom and under what circumstances.

Primary care services can provide primary and secondary prevention and support to teenagers, as well as help them transition to healthy behaviours as adults. Early interventions for mental health disorders are also key for adolescents who are at risk of first onset of such conditions. However, primary care services may underestimate the health requirements of adolescents because they are considered typically healthy. Many adolescents have health concerns that they do not disclose, including those related to substance use, sexual or reproductive health concerns, or mental health problems.

Since 1985, the Teenage Health Unit (THU) at the Herzl has delivered comprehensive primary care to youths aged 12 to 19. Teenagers without a dedicated pediatrician or family doctor are assigned a family medicine resident to provide medical care and are retained as Herzl patients into adulthood. Integrating adolescent voices is key to developing effective services for them, as their particular needs may not always be seen or understood by adults; moreover, centring adolescents in health research can help them to feel empowered to make healthcare decisions.

Participatory methods can engage adolescents in discussing their health needs and understanding why teenagers who could benefit from primary care services do not utilize these services.

In collaboration with the THU, PRAM uses fuzzy cognitive mapping to identify the views of adolescents, providers and school guidance counsellors. The results of these maps will inform a deliberative dialogue to identify and suggest strategies for improved access.

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