Capstone research projects database
The Capstone research project is where students work on real-world issues.
See the Capstone projects TRP students have worked on over the years.
Enabling culturally informed advance care planning
This study explores barriers and solutions to culturally-informed advance care planning through interviews with Tamil-speaking seniors and palliative care providers.
Background
Culturally-informed care can significantly improve the end-of-life care experience for patients and their families. However, this has been proven difficult. Even though healthcare providers acknowledge that culture is an important component of care, they often find it difficult to provide care in the context of culture. To improve end-of-life care by enabling culturally-informed advance care planning. Method: A qualitative study that involved focus groups with healthcare professionals in palliative care and one-on-one interviews with seniors from a Tamil-speaking background. A thematic analysis was used to understand the barriers to developing culturally-sensitive advance care planning. This was followed by one brainstorming session with healthcare professionals to identify possible interventions to improve culturally-informed advance care planning.
Project team
- Philippa Beaden
- Mantha Kumaresh
TRP supervisors
Project advisory committee
- Dr. Nina Yashpal
- Prof. Monika Kastner
- Adijatukubra Musa
- Vijay Saravanamuthu
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Enhancing Meaningful Integration of Patient Partners in Collaborative Healthcare Initiatives: A Qualitative project at CISSS de l’Outaouais
Patient partners—patients, caregivers, or family members—can improve healthcare by sharing their experiences. A study in the Outaouais healthcare system, explored how patient partners collaborate with professionals, identifying barriers like unclear roles and poor communication. Through interviews, participants suggested improvements such as better onboarding, shared leadership, and respectful relationships. The co-constructed final recommendations were reviewed to ensure they met real needs. The study shows that meaningful inclusion of patient partners strengthens healthcare teamwork and offers guidance for other organizations.
Background
The integration of patient partners (PPs)—individuals with lived experience as patients, caregivers, or family members—has become a cornerstone of patient-centered healthcare. Their insights complement clinical expertise and help identify care gaps, improve outcomes, and enhance decision-making. Despite growing recognition, many healthcare organizations struggle to move beyond symbolic inclusion toward meaningful collaboration. Since the early 2000s, healthcare policy has shifted toward co-construction models, where PPs act as advisors, co-investigators, and co-designers. However, without structured support, engagement risks becoming tokenistic.
In Quebec, institutions like Santé Québec and the CISSS de l’Outaouais have formally embraced PP engagement, but operationalizing this commitment requires leadership, training, and systemic change. The CISSS de l’Outaouais, serving a diverse bilingual population near the Ontario border, offers a unique context for studying PP collaboration. The researcher explored the current engagement practices.
Leadership roles in healthcare play a pivotal role in shaping engagement culture, though healthcare professionals (HCPs) often feel underprepared due to limited training and guidance. This gap between policy and practice highlights the need for capacity-building and practical tools. Meaningful collaboration demands environments where PP contributions are valued and acted upon, with clear roles and shared decision-making.
Co-construction, emphasizing equity and mutual respect, remains underutilized. At the CISSS de l’Outaouais, while infrastructure exists, challenges like onboarding delays and unclear governance persist. As the organization undergoes structural reform, there is an urgent need to embed PP engagement into everyday practice through accessible, context-sensitive strategies.
Project team
- Dominique Pilon
TRP supervisors
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Enhancing Youth Engagement Through Measurement-Based Care
The purpose of this project is to enhance the implementation of Measurement-Based Care (MBC) within Youth Wellness Hubs Ontario (YWHO) Networks, with a focus on youth accessing counselling services.
Recognizing challenges in the standardized practice of MBC, this project aims to co-develop and evaluate a youth-friendly tool that fosters engagement and shared decision-making of youth in MBC.
By actively involving youth advisors and employing a comprehensive methodology, the project seeks to improve treatment engagement, increase MBC uptake, and ultimately enhance the quality of counselling services for youth within the YWHO Networks.
Background
This project addresses the challenges surrounding the implementation of Measurement-Based Care (MBC) within the Youth Wellness Hubs Ontario (YWHO) Networks, particularly focusing on integrated counselling services for youth aged 12-25. MBC, the routine use of validated measures to tailor treatment and promote shared decision-making, faces low rates of implementation in practice. The project’s inception stemmed from a comprehensive environmental scan, including a preliminary survey of youth with lived/living experience accessing counselling services. Despite familiarity with MBC, respondents expressed a lack of understanding of its impact, highlighting a crucial gap in engagement.
The YWHO’s Integrated Youth Services (IYS) model, aimed at delivering timely and relevant services, forms the contextual framework for the project. MBC is a vital tool used within IYS, especially in counselling. The project’s overarching goal is to design and evaluate a tool that bridges the identified gaps in youth engagement with MBC. This youth-friendly tool seeks to foster dialogue, active involvement, and shared decision-making in counselling. The expected beneficiaries encompass YWHO partners, including clients, families, staff, and policy makers, with the potential to positively impact health outcomes and service delivery.
The environmental scan, involving a preliminary survey distributed through community networks and organizations, provided valuable insights. Contrary to assumptions that low implementation of MBC was due to youth’s lack of understanding or interest, youth respondents understood the purpose of and were interested in MBC, but reported feeling disconnected from the processes and its impact on their counselling journey. This underscored the need for a targeted intervention to enhance youth engagement in MBC practices. The project’s methodology involves the active participation of youth, youth advisors, and project partners, aligning with the collaborative spirit ingrained in the culture of YWHO.
Together with youth advisors with lived/living experience of accessing counselling services, a tool will be co-developed to foster engagement and shared decision-making in MBC. To understand if the tool may be effective in increasing engagement in care, this tool will be evaluated with a survey and focus groups with youth aged 12-25 who report having accessed counselling services at YWHO presently or in the past. Counsellors who provide counselling services at YWHO will also be asked to evaluate the tool through a survey. The findings of the survey and focus groups will be used to refine the tool for implementation in counselling services at YWHO and wider dissemination.
In summary, this project represents a significant step towards enhancing the quality of counselling services for youth within the YWHO Networks. By co-designing and evaluating a youth-friendly tool, the project strives to empower youth in their counselling experiences, fostering a culture of shared decision-making and improved treatment engagement. The findings are expected to contribute not only to individual treatment plans but also to the broader body of evidence on youth perspectives within integrated youth services in Ontario.
Find out more
Read about the team presenting their research at the #FRAYME2024 Learning Institute.
The team won 'Best poster: Translational Research Program (TRP)' at the Laboratory Medicine & Pathobiology Research Conference (LMPRC) 2024: find out more about award winners.
Project team
- Brianna Dunstan
- Matthew Prebeg
- Izzar Linares
TRP supervisors
Watch their Capstone defense
Examining Access to Vascular Surgery Care for Indigenous Populations in North West Ontario
There is a growing body of evidence suggesting that Indigenous patients across North West Ontario face a higher rate of peripheral arterial disease (PAD) and its associated risk factors compared to non-Indigenous Ontarians. This puts these patients at greater risk for complications of their vascular disease, leading to a disproportionately higher rate of major amputation than the general population. Early consultation with vascular surgery has been shown to improve limb preservation, however, there is a lack of timely referral to vascular surgery for Indigenous patients in this region.
Background
Objectives:
This study aimed to identify systemic barriers impeding access to vascular surgery care by delineating patients’ pathway to vascular consultation, and propose areas for intervention to overcome these barriers, improve vascular care and ultimately limb salvage for Indigenous patients in North West Ontario.
Methods:
Process mapping was conducted to engage key stakeholders to model the flow of the system, and subsequently identify areas where gaps in accessing vascular care exist, requiring intervention. Semi-structured interviews were then conducted with health care workers identified through a snowball sampling strategy to further explore the barriers to accessing vascular care and possible change ideas.
Results:
A high-level process map was developed and analyzed to highlight barriers to care and gaps in knowledge. Ten individuals across six specialties who work within North West Ontario participated in the semi-structured interviews. Key themes that were identified include health systems capacity, physical barriers to accessing care, cultural and societal impact on the patient population, and a lack of sustained provider awareness.
Conclusion:
The barriers to accessing vascular surgery care faced by Indigenous patients with tissue loss are complex and multi-faceted. A systemic and coordinated approach, including suggested interventions like standardization of processes, implementation of photo-sharing systems, education for primary care providers, combining services, and increased research efforts should be employed to address the multitude of interacting factors along the patient care pathway to incite change. Future work will include the development and implementation of systemic changes to improve limb preservation outcomes in conjunction with Indigenous patient representatives.
Project team
- Asha Behdinan
TRP supervisors
Project advisory committee
- Ben Chan
- Mary MacDonald
- Ahmed Kayssi
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Fall prevention: Identifying the knowledge gap among residents
This study explores gaps in fall prevention practices and community resource awareness among medical trainees treating older adults in London, Ontario.
Background
Falls are a significant cause of morbidity and mortality in older adults. As a majority of baby boomers reach the age of 65 and older, the number of incidents related to falls is expected to increase (Salkeld et al., 2000). In addition to the high number of incidents, susceptibility to high severity injury and loss of independence in this population group due to falls are major factors that require consideration. In a 2018 report by Canadian Institute for Health Information, falls among older adults were the most common cause of injuries and the primary reason for hospital visits among this age group. To put it in numerical terms, there are roughly 653,808 Emergency Department visits due to unintentional falls in Canada per year, making this 32% of all reported visits secondary to fall injury (Health Canada, 2020). Health Canada has also reported that falls cause 95% of all hip fractures, with a mortality rate of 20% within the same year. Healthcare costs associated with falls are estimated to be roughly $2 billion a year and account for 85% of all injury-related hospitalizations in older adults (Health Canada, 2020). Informal interviews with several medical residents at the University of Western Ontario revealed that patients presenting with falls are screened for risk factors upon admission. However, once the primary concern has been resolved, they are discharged from the hospital and sent home without a specified plan to avoid future falls. This is concerning as literature suggests a history of previous falls increases the risk of subsequent falls threefold (Rubenstein et al., 2002). These same informal interviews also revealed resident physicians believe they lack awareness of programs offered in their communities for fall prevention, and therefore do not refer patients to these programs. Furthermore, with no structured system in place, they also do not provide any fall-preventative education to these patients. Methods for fall prevention in the elderly population have been studied, and several interventional techniques and programs have been implemented as part of community programs. In Ontario, the primary resource center for its provincial regions is through LHINs (Local Health Integration Networks). In these government-funded organizations, resources such as access to fall preventative methods, including exercise classes, home assessment by occupational therapists, and access to other allied health groups are available. These resources aiming to prevent falls in the elderly can be accessed by self-referral as well as a referral by the patient’s family member, hospital physician, or primary care providers. The need: to gain perspective and identify whether there is a knowledge gap among healthcare providers-in-training in London, Ontario at the University of Western Ontario.
Project team
- Leeda Bashardost
TRP supervisors
Project advisory committee
- Christopher Watling
- Jaspreet Bhangu
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Fall risk assessment at a geriatric rehab hospital
The Fall Risk Screening Tool (FRST) used at Providence Healthcare (PHC) does not accurately reflect the risk profile of older patients who may be the most likely to fall post-admission.
Background
The objective of this study was to identify gaps in and to improve the falls prevention strategy (FPS) of an inpatient rehabilitation facility (IRF) in Toronto, Canada.
Project team
- Catherine Rivers
- Haley Roher
TRP supervisors
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Future directions for AI in Canadian primary care
This project explores stakeholder values, concerns, and needs surrounding the integration of AI tools in Canadian primary health care, with a focus on consent, trust, and regulation.
Background
The scope of the capstone project proposed here is focused on identifying the needs, values and priorities of key stakeholders regarding how ML prediction tools should be applied in primary health care. Canadian primary care is primed for disruption by AI.
Study aims:
- Describe the views of key stakeholders on the use of artificial intelligence (AI) in the delivery and organization of primary health care;
- Develop a novel educational tool for stakeholder engagement in AI-related health services research. Findings: More focused work needed to clarify expectations for patient consent and standards of privacy.
Patients are particularly concerned about digital tech’s risks to the security of their data and what that means for their wellbeing if that data is compromised. Expectation of opt-out option; many cases where a machine can’t unlearn what it learned, and as one participant pointed out, if AI tools become a cornerstone of care, may decrease care quality. Consent may be infeasible when AI tools are used in health system planning, as they already are. The importance of developing plain language tools (cite Alison). Likely consent processes will have to be application-specific. Why do those patients actually want to be able to withdraw their data? This trust in providers view makes it all the more important that providers have the training and evidence base needed to help them use these tools safely in care. 2. Participants generally held a deep mistrust toward corporations and worried that the profit-motivated interests of private AI developers would place Canadians at increased risk of harm, either due to breaches of PHI or biased algorithms. This finding has profound implications for social trust in health institutions, should those institutions be discovered using algorithms that harm the patients. Further, providers’ unwillingness to use AI tools without a supporting base of peer-reviewed evidence will likely limit growth for AI companies competing on the market. Together, these findings underscore the urgent need for regulations that promote the safety and transparent evaluation of health AI tools. Stakeholders to include: clerical; providers (walk-in, community, academic, CHCs, telehealth); administrators; policymakers; CMPA; Centre for Professional Practice; regulatory bodies.
Project team
- Tara Upshaw
TRP supervisors
Project advisory committee
- Andrew Pinto
- Timothy Chan
- Jennifer Gibson
- Carolyn Steel-Gray
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Going Viral: A Targeted Strategy to increase Flu-Vaccine Uptake in Older Adults
This qualitative study explores reasons why older adults in Toronto decline the flu vaccine, revealing concerns about efficacy, side effects, and access, and offering recommendations to improve uptake through education and accessibility.
Background
Background and Objectives: Older adults are at an elevated risk of complications from influenza, influenza-related hospitalization, and death. However, uptake of the influenza or “flu” vaccine by older adults remains suboptimal. This study seeks to understand why older adults (i.e., people aged 65 and above) are hesitant, or refuse to receive the seasonal flu vaccine. Research Design and Methods: For this qualitative research, data was collected through a semi-structured focus group with 5 older adults, living in Toronto Canada, who chose not to take the flu vaccine. Results: From the data collected, it was found that older adults’ perceptions of, and accessibility to the vaccine influenced their uptake. Reluctance to get vaccinated occurred if older adults were doubtful of the vaccine’s efficacy, cautious about its potentially adverse side effects, or unsure whether it was necessary at all, while uptake increased if older adults could easily afford and conveniently access the shot. Discussion and Implications: In order to protect the health of older adults and ensure high vaccination rates in this population, education and public health messaging should explicitly outline the severe risks associated with remaining unvaccinated later in life and provide clear and direct communication to encourage uptake. Polices must ensure that vaccines are widely available and accessible at no cost to older adults, and health care providers must actively educate older patients and endorse flu vaccination, to maximize uptake.
Project team
- Muhammad Mustafa
TRP supervisors
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Health Equity Data Collection Planning Amongst Ontario Midwives
This study explores how Ontario midwives collect and use socio-demographic data to advance health equity in midwifery care, highlighting opportunities and challenges.
Background
Socio-demographic data collection can help midwives understand and manage health disparities among low-risk birthing people and newborns. Despite the potential for such an initiative, little is known about the types of socio-demographic data midwives prioritize in the care they provide. Even less known are the current ways socio-demographic data are used and the challenges faced for collection. Objectives: The goal of this study was to explore socio-demographic data collection of midwifery clients by midwives in Ontario. Methods: Ontario midwives were invited to complete a self-administered survey in the Spring/Summer of 2021. Three hundred and eight surveys were submitted from approximately 1000 workers, 308 surveys were submitted. Descriptive analysis was performed, and then chi-squares were used to compare workers in midwifery practice groups (MPG) and those in alternative models (ALT), such as the Expanded Midwifery Care Model (EMCM) or the Indigenous Midwifery Program (IMP). Results: Overall, midwives agreed that data collection was needed (84.2%), would help them meet the needs of clients served (83.0%) and were prepared to take steps towards health equity (80.0%). When asked to select ten socio-demographic variables that were most important for midwifery care, the most popular items were: persons with mental health concerns (65.3%), language/language fluency (62.2%), housing (56.8%), disability (51.1%), and racial/ethnic background (51.8%). The following were the least popular items: a sense of belonging in Canada (20.1%), the experience of racism/discrimination (21.2%), access to reliable transportation (21.6%), migration status (23.4%), and rural/urban (25.5%). Socio-demographic information was most often reported to be used for client advocacy (80.9%), offering referrals (70.0%) and needs assessment (71.9%). The most common challenges were a lack of standardized tools (53.1%) and limited resources to offer clients (55.3%). Midwives expressed a strong nterest in various forms of training and need to build greater community engagement to understand, set and meet health equity goals. Discussion/Impact: Though participants reported a high commitment to health equity and data collection, midwives disagreed about some of the types of data to collect. Midwives that worked in alternative models had more refined health equity goals, but also faced more challenges in their settings. As the COVID-19 pandemic highlights health disparities and benefits of socio-demographic data collection, our current moment presents a tremendous opportunity to leverage midwives' concerns to implement health equity data collection. Discussions that can build consensus in health equity goals, particularly by learning from practices in alternative models, can foster common ground and thus mobilize such efforts.
Project team
- Ayeshah Haque
TRP supervisors
Project advisory committee
- Dr. Beth-Murray Davis
- Kate Macdonald
- Dr. Claire Betker
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Health Experience and Access for Refugee claimants in Toronto (HEART)
This qualitative study explores healthcare access barriers and facilitators for refugee claimants in Toronto following the 2016 restoration of the Interim Federal Health Program, aiming to inform knowledge translation strategies to improve care navigation.
Background
Goal of the Capstone: The capstone project was designed to identify a healthcare issue that would allow our team to practice the translational thinking and patient-centered approach. We narrowed our topic to underserved communities within the GTA that was a current policy issue in 2019. One of the major goals of the group was to produce a deliverable that would benefit the population of interest.
Rationale for the Refugee Claimant Study: Changes to the Interim Federal Health Program (IFHP) in 2012, which significantly reduced health care coverage for certain categories of refugees, created knowledge gaps amongst healthcare providers and refugee claimants, reducing health care access for refugee claimants. (1). In 2016, IFHP was restored by the newly elected Liberal Government to its previous coverage plan (as it was prior to the 2012 changes); however, little is known about the impact of the 2016 restoration, and the current experience and access of refugee claimants in 2019. The gaps for this population were aligned with our research interests and met the goals of the capstone project (2).
Objective: By examining refugee claimant experiences in 2019, we will explore the refugee claimant experiences after the restoration of the IFHP to pre-2012 levels from the perspectives of a sample of refugee claimants, and add to the gap in the literature post-2016. Our research aims to identify barriers and facilitators of health care access for refugee claimants, and to identify at least one translational strategy to bring positive impact to their experience.
Methods: Before designing the study the research team conducted informal interviews, environmental scans, and community-based outreach initiatives with the objective of defining and clarifying the problem space and beginning to understand the issues faced by refugee claimants from the community that supports them. Our design involved an initial literature search, and subsequently, a qualitative study, conducting 16 semi-structured interviews with a convenience sample. The purpose was to obtain insight into patients’ experience using IFHP, post 2016, as well as other influencers to their access to health care services.
Results: We identified a number of barriers and facilitators to accessing healthcare for refugee claimants which include those that are knowledge/attitudinal, systemic, and structural. Key knowledge/attitudinal barriers for refugee claimants include: a lack of awareness about IFHP coverage, false expectations of healthcare provision, misperceptions about OHIP and how it is obtained, perception of out-of-pocket costs of services, lack of trust in the system and emotions toward status as a refugee claimant. Systemic and structural barriers include the lack of knowledge and information about IFHP by primary healthcare providers/receptionists (gatekeepers), rejection or refusal of IFHP by walk-in-clinics, the lack of information on IFHP and resources to help navigate the healthcare system including misguided information from different sources, and assumptions about levels of healthcare knowledge and healthcare acquisition. (see quotes in Appendix H). In addition, we found that other external barriers such as competing priorities (housing) and mental health concerns were also notable. Major facilitators were identified as: staff workers in support centres, connections within community groups, and other sources of information.
Conclusion: Barriers and facilitators, especially knowledge-dependent factors, were identified in the experience of refugee claimants in Toronto. Our project aims to develop knowledge translation resources for refugee claimants to deepen their understanding of IFHP and their ability to navigate the healthcare system.
Project team
- Ibrahim AlShaygy
- Christina Beharry
- Jonathan Sangjin Lee
- Connie Putterman
TRP supervisors
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