Speaker 1: Thank you all for coming to our defense over the past year. Our team has worked really hard on our capstone project, and we're really excited to share our work with you all our project involves engaging with the lower central Hamilton community to identify resident health needs and key considerations for the delivery of health and social services. I'll start off with an introduction of our team and how our project journey started. Our team consists of Morgan Carolyn and myself so big show we connected last spring over our shared working styles and passion for community engagement health equity and improving health care access. More importantly, we wanted to identify our project that had a real world impact our personal ties to Hamilton also influence our choice of Hamilton as our target community, Morgan and I studied at McMaster and Carolyn currently lives and works there as a registered nurse. Through our shared passion and interest the quest to find our capstone project began the core motivation for this project was a desire to bridge health equity gaps in Hamilton. Health equity is achieved when an individual has the opportunity to receive care that meets their needs, regardless of their health or social status. In this way, it removes circumstantial differences between individuals that can impact one's health. Social determinants of health are non medical factors that play a significant role in influencing one's health outcomes and, more importantly, health equity. These common factors include income, education, social exclusion, employment, housing, food insecurity and physical environments. It's estimated that 30 to 55% of one's health outcomes are health outcomes are influenced by the social determinants of health and these differences in health outcomes contribute to health inequities. So when thinking about how to improve overall health and work towards health equity, we need to think about addressing these determinants. In line with this, Ontario Health has committed to this vision of achieving health equity by prioritizing the creation of a connected health system through the development of Ontario health teams, improving access to primary care, the provision of tailored care and community engagement principles. Likewise, Hamilton, Ontario has been at the forefront of discussion around health equity through the publication of the Code Red reports, which uncovered the disparities in the socioeconomic and health outcomes across all neighborhoods in Hamilton from 2010 to 2019. The first iteration showed that a region in Hamilton called Lower Central Hamilton had the worst socioeconomic and health outcomes in the entire city. A decade later, there was little to no improvement in these outcomes as it still had the highest poverty rates and there was a further decline in the average lifespan and an increase in hospital and emergency room visit rates. This revealed a need for Lower Central Hamilton residents' health needs to be addressed through priority health care intervention. In efforts to address this need, the Hamilton family health team spearheaded the development of a new primary health care clinic at the Eva Rothwell Centre, which is an established hub in Lower Central Hamilton. As HVID and their partners worked to launch this clinic, we leveraged the momentum of new initiatives by engaging in a parallel project to identify current health needs and explore how can care be delivered in a way that suits both residents and providers, addressing a gap that currently exists. With that comes our research project. Our primary research question was, what considerations can facilitate the context-appropriate and sustainable delivery of health services within Lower Central Hamilton? Context-appropriate refers to delivery of care that's specific to the health needs of residents, while sustainable delivery of services refers to providers being able to meet residents' needs at present and into the future. We had three objectives. The first was to identify the health needs of Lower Central Hamilton residents. Health needs refers to requirements needed to achieve and maintain physical, mental and social well-being. The second was to identify key considerations related to the delivery of health and social services. The third objective was to identify barriers and insights related to our own community engagement efforts in this community. Next, I'll take you through our research design and how we executed this project. We chose a community-engaged research design and used a community-based engagement approach outlined by WHO, where the community is consulted and involved to improve access to health services and programs. A key component of community-engaged research and community engagement is for those conducting the engagement to foster critical self-reflection and identify key insights during the process. The study involved two cohorts of participants, the first being Lower Central Hamilton residents without attachment to a primary health care provider, and in this cohort we recruited 12 residents. And the second being health care and social service providers currently delivering care within Lower Central Hamilton. In this cohort, we recruited 15 providers. Translation services were also available throughout the entire project to engage with non-English-speaking residents. We conducted semi-structured interviews with all participants via telephone, Zoom or in-person, and all participants received a $25 gift card at the end. Residents also received a list of community resources for further support. Residents were asked about their health, current and desired access to health and social services, while providers were asked about their current position, methods of interprofessional collaboration and their client population health needs. Additionally, to aid in comprehension during interviews with residents, we created a tool to visualize the social determinants of health for residents with limited English and health literacy. Interview transcripts from all participants were analyzed on NVivo 14 through qualitative thematic analysis and inductive coding, where themes were generated directly from the data.

Speaker 2: We're now going to go through the results of our research. To start, we're highlighting the most relevant demographic data, starting with residents. 33% of the residents that we interviewed were established residents and 67% were newcomers. 58% of residents were male and we had an almost equal distribution of residents who identified as black and white. The service providers that we interviewed were split evenly between healthcare and social service workers, with one identifying as both. Providers had practiced in Lower Central Hamilton for a mean of 16 years. At this time, we'd like to call back to our first research objective, which was to identify the health needs of Lower Central Hamilton residents. We fulfilled this objective by defining resident needs as described by both residents and providers. Residents identified physical health needs, including occasional colds and flus, MSK pain, stress, and sleep problems. Providers identified more complex priority physical health and social needs, including lack of access to basic necessities, infection and wound care, and management of chronic conditions and medications, just to name a few. The most frequently noted resident mental health needs mentioned by providers were substance use and addiction, anxiety and depression, trauma and schizophrenia and mood disorders. Providers also identified children, newcomers, and adults as priority populations. Next, we'll call back our second research objective, which was to identify key considerations related to the delivery of health and social services in Lower Central Hamilton. The results of thematic analysis of both resident and provider interview transcripts were organized into three categories, enablers of health, barriers to health, and participant recommendations. Our first set of themes fall under the category of enablers to health, which we define as factors that facilitate residents in meeting their health needs. We found that residents demonstrate resilience and self-sufficiency in the face of challenges, that they use their community in the form of family members and interpersonal networks to meet their social and health needs, and that they meet their needs by integrating their personal culture into their lives and taking advantage of their neighborhood's proximity to parks, grocery stores, churches, community resources, and transportation options. Next, within enablers of health, we found four specific service delivery components. First, providers emphasize the importance of patient-centered care, which means addressing both physical and mental health needs alongside social needs to promote health equity. Residents noted that it's helpful when one provider serves as a system navigator, connecting them to other services. Second, building trust between providers and residents was described as essential, as residents are often hesitant to trust providers. Participants acknowledge that while trust takes time to build, it's a worthwhile commitment. Next, the use of communication channels between residents and providers was found to be a significant enabler to care delivery. This includes both formal channels, such as newsletters, and informal channels, such as casual conversation. Finally, participants recognize that care delivery also involves the cultivation of provider-to-provider relationships. Agency directors depend on frontline staff to stay attuned to community needs, and providers also collaborate across the Lower Central Hamilton provider network by creating joint programs, serving on committees, and referring clients to one another. The second category of our results is barriers to residents' health. Described as factors that inhibit residents from meeting their health needs. Both residents and providers acknowledge that economic barriers to health were unemployment and limited income. These barriers were particularly relevant to newcomers. Another type of barrier were environmental barriers, which included trouble finding or affording housing, and dissatisfaction with physical environment related to poverty, drug use outdoors, and feeling unsafe in the neighbourhood. Again, this was more prevalent for newcomers. Other barriers to health include difficulties with accessing health care. This can be due to residents' negative past experiences with receiving care and stigma, challenges with continuity of care, and strain on organizational resources, often related to trouble securing and maintaining funding. Newcomers in Lower Central Hamilton described additional barriers to their health, including a lack of community and challenges with health care navigation. The third category of our results is participant-suggested recommendations about how care delivery in Lower Central Hamilton could be improved to better meet residents' health needs. We propose that these recommendations could be implemented within primary health care settings to achieve the goal of addressing residents' social determinants of health. The first recommendation is to improve resident access to care. There's a need to increase the availability of consistent primary health care, as most residents currently utilize walk-in clinics. Given residents' complex health needs, providers identify a need to provide integrated care where care is provided through a collaboration between different providers. The second recommendation was centred around improving the patient experience by adopting a harm reduction approach and facilitating a positive experience in health care settings, such as improving comfort in waiting rooms, and pairing patients to a provider based on their needs. The third recommendation is to provide further tailored education and training to both residents and providers. Residents expressed a specific interest in learning about topics regarding overall body health, nutrition, and mindfulness. Providers expressed a desire to grow knowledge in Lower Central Hamilton-specific topics, such as gang activities, mental health, and mental health. The final recommendation was to engage with the community through hiring staff from within the community to empower residents and build trust. Additionally, providers are encouraged to create informal opportunities for community, and as such, view casual conversation with colleagues and family members as a way to build trust. The final recommendation was to engage with the community through hiring staff from within the community to empower residents and build trust. Providers are encouraged to create informal opportunities for community, and as such, view casual conversations with residents as an essential component of their role. Engagement can also take the form of providers sharing physical spaces with clients and collecting feedback from clients about if their current services are meeting needs. We'd now like to shift the perspective from thematic analysis to the last section of our results, which are researcher engagement insights. To recall, the last research objective we had was to identify barriers and insights related to our own community engagement in Lower Central Hamilton, which happened over the course of this project. Over the last 12 months, all three of us have critically reflected on our successes, challenges, and the strategies that we use to navigate these challenges. We've distilled our learnings into 10 simple, specific, and actionable strategies that can be used to guide how someone, like a provider or a researcher, may choose to engage with the Lower Central Hamilton community. Some of these strategies include prioritizing in-person engagement, taking time to build trust, leveraging the experiences of individuals currently serving the community, and many more.

Speaker 3: We'll now discuss the aspects of this work that are novel and how they will be impactful. The biggest impact of our work will be at the local level in Hamilton. Since the publication of the Code Red reports, efforts have been made to address health inequities in Lower Central Hamilton. We presume that agencies have identified strategic mandates that work to mitigate the effects of the social determinants of health, but if they've described their strategies in progress, as far as we're aware, they have not been published, so it's hard to learn from them. For this reason, our work is a novel contribution to research that's specific to Lower Central Hamilton because we've captured experiences from both residents and providers and distilled this information into actionable recommendations for widespread dissemination. The short-term impact comes from sharing our work with organizations in Lower Central Hamilton so that they may apply the actionable recommendations from our results in a way that's feasible and makes sense for them. The ultimate goal of this work and the desired long-term impact would be to improve the health outcomes and the social determinants of health for residents in Lower Central Hamilton. Let's now take a step back to assess the greater relevance of this research outside of Lower Central Hamilton. Our work contributes to the body of literature on the social determinants of health and principles of patient-centered care, but we recognize that these contributions are not necessarily novel. Instead, we've substantiated what was already known about these topics and contextualized them within a specific community. Within this broader context, our work offers a unique contribution to the literature by serving as a case study for addressing health inequities in historically marginalized communities. It does so by tying together the perspectives of both residents and providers through a community-engaged approach. While there are other case studies and needs assessments that have done similar work, they don't necessarily encompass the diversity and perspectives that have been represented here. The broad impact of this contribution is that, in theory, the methodology and engagement processes from this case study could be extrapolated and applied by researchers in different environments to help address their most prevalent social determinants of health and to create health interventions that are specifically tailored to their unique circumstances. These intended impacts will only be actualized if we share our results through knowledge dissemination strategies. To do so, we've devised the following plan. The first step in knowledge dissemination is to create something that can actually be disseminated. Thus far, we've distilled our work into an academic and scientifically rigorous manuscript. We've also presented at three research conferences where we've shared the background and methodology of our project, advocating for a community-engaged approach for working with individuals facing inequities. For next steps, we'd like to apply to submit our manuscript for publication and present results at other conferences so that we can share our results in addition to our background and methodology. Finally, and most important, using our manuscript as a starting point, we've written a report to be shared with the Lower Central Hamilton community. This report discusses all sections of our results, including residents' health needs, key considerations for service delivery, and our insights from community engagement. This report is intended to be simple, specific, and actionable. It's also designed to be more accessible than our manuscript so that we can share it with residents, providers, and other agencies in the area. Now, we recognize that our research has limitations which might have bearings on the nature of our results. While we did reach data saturation, a larger sample size could have provided more diverse opinions and experiences. The residents that we interviewed were all adults and mostly newcomers. So with more time and resources, we would have aimed to include youth and more established residents to broaden the perspectives represented. In addition, residents were mainly recruited from the Eva Rothwell Centre, as that proved to be the most effective recruitment site. But we recognize that this may not fully represent all Lower Central Hamilton residents, and again, with more time and resources, we would have expanded recruitment to other organizations. As we wrap up, we'd like to leave you with some key insights. When it comes to addressing health inequities, change doesn't happen overnight. At a provincial level, addressing health inequities has been identified as a priority. But at the end of the day, impact is often realized at a neighbourhood level. We've engaged with both residents and providers to capture their perspectives on what residents' health needs are and what's important to the delivery of primary care in order to address those needs. Achieving health equity requires collaboration between many people in many fields over a long period of time. Addressing the needs of Lower Central Hamilton residents is no exception to this. Our work plays a small but significant part of moving towards a vision of health equity in Hamilton. Now, before we conclude our presentation, we would be remiss not to acknowledge and express our gratitude to everyone who supported this project and our journey. First, we'd like to thank our academic advisors. They've been supporting and guiding us before this project even existed. Our project advisory committee constantly offered their insight and feedback to make this project a success. We offer a special thank you to the team at the Eva Rothwell Centre for welcoming us into their space and showcasing the strong community that exists in Lower Central Hamilton. This work was done with the support of the Hamilton Family Health Team, including Dr. Brian McKenna and Anne Howarth. Thank you for sharing with us your vision for the future of primary health care in Hamilton. More than anything, we would like to thank all those who participated in our project. Thank you to the residents and providers of Lower Central Hamilton for your trust in our team and your willingness to share your knowledge and experiences. That's all we have for you today. Thank you all for coming. Thank you all for listening, and we'll now turn it over for questions. Thank you.