For several years, researchers at the Lawson Health Research Institute have been working with partners at the Public Health Agency of Canada, ICES, and the Alliance for Healthier Communities to find better ways to measure and understand the health impacts of homelessness i n Ontario. In March 2022, they published an article in The Lancet Public Health showing that the rate of COVID-19 vaccination is disappointingly low among people with recent experiences of homelessness. We sat down with two of the authors, Salimah Shariff and Richard Booth, to talk about the research project that led to this study, what they learned from it, and the implications of their findings.

This research program began in 2018 with a study that aimed to quantify homelessness in Ontario using health system administrative data. It achieved about 35% sensitivity – meaning about 35% of people experiencing homelessness could be identified. The research team speculates that sensitivity may have improved to about 50% after CIHI introduced a policy requiring housing status to be recorded at hospital admission and discharge, and practice data from community health centres was linked. Then the COVID-19 pandemic arrived, and the researchers turned their focus to how COVID-19 was impacting people experiencing homelessness. 

Perhaps unsurprisingly, they found that this population had disproportionate amounts of infection, hospitalization, ICU admission, and severe illness. These findings received nationwide media attention and contributed to policy change that would make people experiencing homelessness a priority population for vaccination. The next step was to determine whether this policy change was having the desired effect. The research team compared vaccination rates among 23,000 people with recent experiences of homelessness with the rate in the overall population. They found that despite being named a priority population, those experiencing homelessness had a 25% lower rate of vaccination for a first dose and 34% lower rate for a second dose by the end of September, 2021. As Booth notes, “We weren’t necessarily surprised that the rates were lower. The surprise was the magnitude of difference.”

Not all the news was bad, however. People experiencing homelessness had higher COVID-19 vaccination rates if they had accessed care from a community health centre. Until qualitative research is complete, the research team can’t confidently pinpoint why, but they offered some hypotheses based on observation and inference. They note that many people who are structurally vulnerable feel skeptical of authority and are uncomfortable accessing care or information from public health units or government websites. Others may be eager to get vaccinated but don’t have access to the internet to find out where vaccines are available or how to access them. Primary healthcare organizations overcome skepticism through relationship-building and trust. They provide multiple, low-barrier ways to access care, including direct outreach, harm reduction, and social programs. Many also help overcome digital barriers by providing internet-enabled devices and data to people in need of them.

The Alliance for Healthier Communities as a Learning Health System for primary care: A qualitative analysis in Ontario, Canada. This article in the Journal of Evaluation in Clinical Practice describes what we learned from a series of interviews with Alliance stakeholders in 2019 and 2020, when our learning health system was emerging. 29 staff from six CHCs and one from the Alliance described what motivated them to be part of a learning health system, and what they saw as barriers and enablers. Other primary care organizations may benefit from these insights in their own development as learning health systems.

A Practice-based Methodology on Conducting a Collaborative Scoping Review with PRISMA-ScR Model for the Separated Refugee Youth Project. This article, published in the Journal of Scientific Research and Reports, describes how one research team incorporated a scoping literature review into a community-based research project about the impacts of family separation on refugee youth. By incorporating several other tools into an existing review methodology, the team were able to ensure that the whole review process was collaboratively designed and executed, with high-quality results.

Service utilization patterns and characteristics among clients of integrated supervised consumption sites in Toronto, Canada. This article in Harm Reduction Journal describes and compares access to and uptake of co-located and external services among clients of supervised consumption services (SCS) embedded in harm reduction sites and community health centres. The populations were found to be demographically similar with different patterns of drug and SCS use.

Assessment of the Implementation of Safer Supply Pilot Projects. This independent report by Dale McMurchy consulting is a preliminary assessment of safer supply pilot projects in British Columbia, Ontario, and New Brunswick. The programs and the assessment were funded by Health Canada, through the Substance Use and Addictions Program (SUAP). Overall, the report finds that the programs have been extremely valuable to clients, and that there needs to be funding to expand access to them. It also describes five key learnings for developing and implementing such programs effectively.

Addressing Cervical Cancer Screening Inequity among Newcomer Women via HPV Self-Sampling. This research project was developed to generate evidence about community-based, culturally safe ways to promote HPV screening by self-sampling amongst under- and never-screened women within immigrant communities. The report is available in English and French, and it is accompanied by a "Myths vs. Facts" tool, available in nine languages.

Virtual Care in Canada: Strengthening Data and Information. This report from the Canadian Institute for Health Information (CIHI) explores the current landscape of Canadian virtual care data and information. It includes a snapshot of available virtual care data from CIHI, the provinces and territories, and pan-Canadian health care organizations. It also recommends new areas of pan-Canadian focus for measuring the quality and accessibility of virtual care. To learn even more, visit CIHIs Virtual care in Canada web page or email your questions to virtualcare@cihi.ca. 

Environmental Scan of Interpretation Services in Kitchener, Waterloo, Wellesley, Wilmot, Woolwich. This environmental scan was developed to help advance access to interpretation services in the area around Kitchener-Waterloo, but the resources included reach well beyond that area. We're sharing it here because we think it may be useful to your organization and community partners.

Addressing Cervical Cancer Screening Inequity among Newcomer Women via HPV Self-Sampling. Access Alliance conducted this research to build evidence on community-based and culturally sensitive ways to promote HPV self-sampling for cervical cancer screening among women who were never-screened or under-screened. They found that culturally appropriate self-sampling kits, adequate education and training, and availability of safe and accessible healthcare were key enablers for increasing the rate of cervical cancer screening in this population. See links at bottom of the article to access the report in English and French as well as client-facing fact sheets in nine languages.

Is your organization is new to research? Up to $10K is available from the Canadian Institutes of Health Research to help plan, implement, evaluate, scale, or spread programs that support LGBTQIA/2S health and wellbeing. To be eligible, your organization must have no prior research experience or be the current recipient of a grant from the same program. Projects must have an intersectional lens. More information here.

Toolkit for Advancing Collection and Use of Sociodemographic Data in Primary Healthcare. To support our members in their collective commitment to reach 74% completeness of sociodemographic data by 2024, the Alliance conducted a study to examine how sociodemographic data is collected and used in CHCs. The output of this study is a Sociodemographic Data Toolkit which includes a report summarizing the study findings (FR) and a list of helpful resources and tools for organizations to adapt or adopt (FR).

Recorded Webinar: Understanding the 2021 Practice Profile. On April 12, 2022, the Alliance hosted a webinar to help orient members to the newly updated CHC practice profile. This resource is produced annually by the Alliance for Healthier Communities and the Institute for Clinical Evaluative Sciences (ICES). It combines Community Health Centre (CHC) Electronic Medical Record (EMR) data with provincial billing and administrative data to provide information on the clients served by Ontario’s CHCs. It has now been revamped and updated for 2021. The video recording, slide deck, links to the practice profile and its appendices are available here along with other resources to help you understand and use the data.

Toolkit - Access to COVID-19 Antiviral Treatment (Paxlovid). This toolkit consists of guidance for healthcare providers as well as an informative patient handout.

The QIP Navigator is open until June 30. This online tool allows health care organizations in Ontario to submit their annual organizational Quality Improvement Plans (QIPs) to Ontario Health. Questions? Contact QIP@OntarioHealth.ca.

New knowledge hub from Access Alliance and the Canadian Association of Community Health Centres (CACHC): CACHC and Access Alliance have partnered to produce this centralized hub of multilingual resources created by and for community health centres. By adopting or adapting tools developed by your peers, you can save yourself the work of building them from scratch.

Parlons-en! In 2021, the Ontario Harm Reduction Network released Connecting: A Guide to Using Harm Reduction Supplies as Engagement Tools. A French-language translation, Le guide Parlons-en! Le matériel de réduction des méfaits comme outil d’interaction has now been released. This guide provides clear and stigma-free information that can help frontline harm reduction workers connect meaningfully with people who use drugs.

The Alliance has developed four new 1- and 2-page reports about comprehensive primary health care. These were created to help support you in advocating for the sector when talking to policymakers, system partners, or other leaders and decision-makers. They define primary health care, demonstrate what we mean when we say it's the foundation of the health system, and provide evidence to support our claims that this model works.

Some may want to print these up and share them as hardcopies, so we've included a QR code on each one. This will take the reader back to the electronic version, so they can follow all the hyperlinks.

Please send comments, suggestions, or story ideas to LHS@AllianceON.org.

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