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.
Primary Stroke Prevention: Comparison of Information Sharing Preferencesof At-risk Patients with Family physicians practices
This mixed-methods study examines stroke literacy and communication gaps among at-risk patients, stroke survivors, and family doctors, revealing a need for more integrated and personalized stroke prevention efforts in Canada.
Background
Thousands of Canadians suffer from stroke yearly. Stroke can be life-altering or fatal. Much of stroke prevention in Canada is geared towards secondary prevention, but greater efforts are needed to improve primary stroke prevention. We utilized a mixed study design using quantitative (surveys) and qualitative (focus groups, interviews) methods to study stroke literacy in at-risk public (e.g. patients with hypertension, dyslipidemia, and atrial fibrillation), stroke survivors and family doctors. We also examined the preferences and experiences of physician-patient communication on stroke and risk factor modification in all three groups. While our findings support existing literature showing inadequate stroke literacy in at-risk patients, we discovered novel gaps in patient education provided by family doctors regarding stroke and its risk factors.
Key findings:
- Lack of awareness regarding stroke risk factors, prevention, resources/programs, post-stroke complications and effect of stroke on quality of life among at-risk patients.
- Limited communication about personalized stroke risk, risk factor management and prevention between family physicians and patients with preventable risk factors.
- Need for an integrated approach to deliver information about stroke prevention to at-risk patients.
Project team
- Saddaf Syed
- Gurpreet Jaswal
- Tazeen Qureshi
- Alejandro Fernandez
TRP supervisors
See our community directory for more on committee members.
Project POTS (Postural Orthostatic Tachycardia Syndrome)
POTS patients in Canada are often misdiagnosed, dismissed or poorly managed. Physicians often refer these patients to other specialists rather than initiating care themselves. There is a need to equip physicians - particularly in primary care - to recognize, diagnose & manage POTS.
Background
POTS or Postural Orthostatic Tachycardia Syndrome is a chronic & disabling condition caused by a dysfunction of the autonomic nervous system. It primarily affects women of reproductive age and is underdiagnosed and under-recognized. It takes a POTS patient 2-12 years to get a diagnosis. Our study focuses on identifying and addressing the barriers to POTS diagnosis & care at the primary care level. We will engage primary care physicians to understand their experiences and co-create an intervention that improves the patient journey for POTS patients in Canada.
Project team
- Asnia Shah
- Mikhail Lobo
- Linette Penney
- Vedant Shukla
TRP supervisors
Prospective Assessment of Translation in Healthcare
Application and review processes for Disease Team grants were misaligned with the needs of applicants and reviewers.
Background
Our project addresses a problem in the Ontario Institute of Regenerative Medicine’s (OIRM’s) evaluation of Disease Team grant proposals. Applicants preparing for clinical trials were often unaware of their project’s place in the Disease Team funding spectrum. Further, reviewers found it challenging to convey their feedback in a succinct, tailored manner, given the wide variety of proposals they receive.
Project team
- Vaishnavi Batmanabane
- Meghan Lofft
TRP supervisors
See our community directory for more on committee members.
Rare Direct
This study explores the diagnostic experiences of Canadian rare disease patients and caregivers, combining survey data with an international environmental scan to identify needs and inform strategies for faster diagnoses.
Background
For patients with rare genetic conditions, getting a diagnosis is a struggle. While there is abundant research on the challenging aspects of this diagnostic process, most of the research is not taken from the patients’ perspective. Our research focuses on the patients' and caregivers’ perspective, in hopes that by better understanding this stakeholder, we could devise potential ways to address their specific needs, thereby improving their experience of this process in a manner that may contribute to a more timely diagnosis. After discovering the general need for timely diagnosis of rare disease patients, we went to the literature to further define the need. There, we found many sub-needs within the larger need for timely diagnosis. We wanted to specifically define how do the Canadian patients, our primary stakeholder, view this problem. To answer this question, we surveyed patients, asking questions geared towards understanding their views of their diagnostic odyssey. At the same time, we wanted to understand how other locales are attempting to fill this need, by doing an environmental scan on how different countries approach this need for timely diagnosis for patients.
Project team
- Renee Hofstedter
- Anat Segal-Shalev
- Weixi Li
TRP supervisors
Project advisory committee
- Nick Watkins (Genetic Counsellor, Mount Sinai)
- Lucy Osborne (U of T)
- Robin Hayeems (CHES, Child Health, Sick Kids)
See our community directory for more on committee members.
Re-Imagining Occupational Smoke Mitigation Strategies for Canadian Wildland Firefighters: A Participatory Study
Our team united with a common passion for tackling the problem of air pollution exposure and our current mission is to improve health and safety for wildland firefighters in Canada who are exposed to smoke for many months.
Focused on enhancing respiratory protective equipment tailored to the unique challenges of wildland fire contexts, our interdisciplinary team aims to empower and engage with those on the front lines. Our overarching goal is to develop innovative solutions that effectively mitigate risks, ensuring the well-being of wildland firefighters, and bridging the gap between evidence and impact to protect our protectors during wildfire season.
Background
Our project emerged from a shared concern for the health and safety of wildland firefighters facing increasingly challenging conditions.
Recognizing the critical role respiratory protective equipment plays in their well-being, we assembled a diverse team of engineers, researchers, and experienced wildland firefighters. Through collaborative efforts and a human-centered design approach, we aim to improve and innovate existing equipment to better align the demands of wildland firefighting.
By combining technical expertise with on-the-ground insights, we aspire to contribute meaningful advancements to the field, ultimately enhancing the protection and resilience of those who safeguard our wildlands during fire seasons.
Through iterative collaboration and a deep understanding of on-the-ground realities, our project aspires to make meaningful advancements in the field, ultimately contributing to the heightened protection and resilience of those who tirelessly safeguard our wildlands.
Project team
- Sumegha Jain
- Janna Mohamed
- Arani Ravichandra
TRP supervisors
Removing Barriers To Wound Care: Applying Appreciative Inquiry To Improve The Management Of Wounds Within The Matawa First Nations
This study uses appreciative inquiry to co-design a culturally appropriate intervention to support remote wound care delivery in Matawa First Nations communities.
Background
The purpose of this research study is to better understand the problem space of remote wound care within the Matawa First Nations communities. Ultimately, we hope to use explorative research to collect data that will inform requirements for the design of a resource or intervention that can be useful to help the Matawa First Nations Health Care team (MHT). We hope the intervention will help bridge the service gap and access to wound care within the Matawa First Nation Communities in Northwest Ontario. Objectives To understand the cultural environment, patient and provider experience in a holistic manner in order to improve wound care competency within communities; To understand and frame the problem space in a way that reflects the providers and the resources they have. To maintain cultural appropriateness when speaking with members of the Matawa First Nations communities and when co-designing an intervention with the MHT. To improve wound care competency in the Matawa First Nations community settings to prevent complicated wounds leading to amputations. To engage various Matawa healthcare providers. To promote the clinical wound care capacity of the MHT. To co-create a resource that can work within communities and that will address remote wound care needs. Methods and Procedure:The specific methodology of appreciative inquiry will be employed in this research study, and it will focus on the strengths of providers and their ability to give care. The study aims to inquire, imagine, innovate and implement intervention using multiple rounds of interviews that will improve wound care within the Matawa First Nations communities. This study will aim to engage Matawa health care providers in informal interviews to help with this process. The first phase is to inquire, which will include interviews with MHT members. Questions relating to wound care processes will be asked. The second phase is to imagine an improved wound care process, which will include individual and team brainstorming sessions. Our research team will list the themes obtained from phase one of the data on a draw.io document. These will all be related to the wound care process. The team will work with experts to ideate and list solutions to help keep what works within communities. The third phase is to innovate and come up with an intervention or resource based on the ideas provided in phase 2. Following the organization of the ideas and their ranking based on feasibility, ease and resources our team has available, we will come up with an intervention. Once an initial prototype of the intervention is created, we will reach back out to the MHT and ask for their input on the prototype. The final implementation phase will be to carry out the intervention within the MHT setting. This will allow for input and feedback from partners and providers, in the form of one final feedback interview.
Project team
- Margarita S. Elloso
- Vida Maksimoska
TRP supervisors
Project advisory committee
- Heather Boon
- Jeremy Caul
See our community directory for more on committee members.
Reusable diapers
Looking at promoting cloth diapers for low-income families and educating them and the public about safe washing techniques
Project team
- Leslie Shai
Revitalizing Tenant Wellness: Piloting the Implementation of a Wellness Hub at 100 High Park Avenue for Greater Access to Long-Term Mental Health Services for Tenants
The Toronto Community Housing Corporation (TCH) provides affordable social housing to a community of residents. In these community housing buildings, residents face various challenges such as mental health, safety and security, addiction, and economic challenges.
In partnership with the West Toronto Ontario Health Team (WTOHT) and TCH, we aim to implement a Wellness Hub to increase access to key resources, namely mental Health Resources.
Background
Toronto Community Housing Corporation (TCHC) is a non-profit group and stands as the largest social housing provider in Canada (About Us | Toronto Community Housing, 2023). The organization plays a pivotal role in addressing housing needs, by providing subsidized or rent-geared-to-income shelter to over 43,000 people across 106 of Toronto’s 158 neighborhoods (About Us | Toronto Community Housing, 2023). The 89,000 residents under TCHC’s care are a diverse tapestry, representing a wide spectrum of backgrounds encompassing age, education, language, mental and physical abilities, religion, ethnicity, and race (About Us | Toronto Community Housing, 2023).
The TCHC location of focus in this pilot project is 100 High Park Avenue in West Toronto. There are 619 residents residing in this building, 80% of which are older than 25 (Refer to Appendix A for additional demographic data). 100 High Park Avenue is a medical desert with inadequate access to primary healthcare services, substantially less for the population density compared to other locations across the city. Challenges include increased mental health issues, poverty, and other circumstances that render residents vulnerable. As a result, residents face a multitude of concerns, including personal drug abuse or overuse, feelings of unsafety within the community, and instances of intimidation and attacks directed towards elderly residents, among others. Accessible routine primary health care services such as psychosocial services, health promotion and disease prevention are crucial to the long-term well-being of tenants and the surrounding community.
The West Toronto Ontario Health Team (WTOHT), comprising 35 organizations in the West Toronto area, plays a vital role in coordinating care between hospitals, primary care, home and community care services, long-term care homes, congregate settings, and various other healthcare services (About Us | West Toronto Ontario Health Team, 2023). Their goal is to deliver an improved and seamless healthcare experience for those receiving care in West Toronto.
In a collaborative effort TCHC, WTOHT, and our capstone team seek to address the multifaceted challenges faced by 100 High Park Avenue residents. Our team will facilitate an ideation process to effectively engage key community stakeholders and co-create a wellness hub tailored to the unique needs of TCHC residents at 100 High Park Avenue. This endeavor will not only seek to provide immediate support but also ensure the sustainability of these interventions, making a positive, lasting impact on the communities we serve. By bringing together the resources and expertise of both organizations, we aim to create a model that fosters well-being and resilience among TCHC residents, ultimately enhancing their overall quality of life and community cohesion.
- Problem Statement: Tenants experiencing mental health challenges in the TCH 100 High Park Avenue location, a known medical desert, have inadequate access to necessary mental health services, further exacerbating residents’ substance use and safety concerns.
- Need Statement: The need is to increase the accessibility and long-term use of mental health care services through the community Wellness Hub for tenants residing in the TCH 100 High Park Avenue location.
- Research Question: How might we develop and integrate accessible mental health services through the wellness hubs for all tenants at 100 High Park Avenue to improve the long-term follow-through of their care, overall health and safety?
Project team
- Sumaya Bhatti
- Anabela Cotovio
- Julia Kulczyski
- Osaru Omoruna
TRP supervisors
Roadmap to Bridging: Developing a Unified Discharge Process
A quality improvement project at CAMH’s Bridging Clinic examines barriers to care coordination, addressing a growing backlog of post-discharge mental health clients, particularly worsened during COVID-19.
Background
According to the Survey on COVID-19 and Mental Health, one in four (25%) Canadian adults (18 and older) self-reported symptoms of a mental health disorder, an increase from the one in five (21%) reported in Fall 2020 (Government of Canada, 2021a). One in five individuals (18.1%) aged 12 and older reported the need for help for their mental health in the Fall of 2020; and (45.0%) felt that their needs were either unmet or only partially met (Government of Canada, 2021b). Out of those with unmet needs, 20.9% reported features of the health care system, such as accessibility, as a barrier to meet their care needs (Government of Canada, 2021). The lack of coordination and fragmentation of Ontario's mental health care system generates confusion, hinders clear navigation of the system, and results in unnecessary emergency visits (Roadmap to Wellness, 2020).
The World Health Organization (WHO) defines care coordination as “a proactive approach to bring together care professionals and providers to meet the needs of service users to ensure that they receive integrated, person-focused care across various settings” (World Health Organization, 2018). Coordination of care or continuity of care (COC) has also been described as “the degree to which a series of discrete health care events is experienced by people as coherent and interconnected over time and consistent with their health needs and preferences” (World Health Organization, 2018). The lack of coordinated and continuous care in the mental healthcare space remains a significant challenge that greatly impacts costs and the patient experience. It has been shown, that without effective and timely follow-up and COC post-discharge from inpatient psychiatric care, clients are vulnerable to relapse within 30 days of discharge and are found to be at greater risk for suicide within six months (Rudoler et al., 2017).
To better understand this problem space, the Capstone team met with different stakeholders of the mental health system, including people working at the Centre for Addiction and Mental Health (CAMH) and in government. One of these meetings uncovered an opportunity at CAMH's Bridging Clinic (BRDG) for a quality improvement project regarding the navigation of the system. Dr. Andrea Waddell was leading this initiative and after several meetings to discuss goals and the project, working together was a good fit due to our shared interest in quality improvement in mental health care. Established in 2017 in Toronto, Ontario, CAMH’s BRDG aims to provide low barrier and rapid access for acute care post-discharge from mental health and addiction services. The clinic is intended as a mechanism to provide continuity of care while clients are connected with longer-term solutions. This service is provided to individuals who identify as needing support as they transition from hospital to the community. Individuals can access the service for a maximum period of three months. BRDG staff is composed of a leadership team (clinical directors and managers), administrative team, clinicians (social workers and nurses) and the physician team (psychiatrists). BRDG plays a role on the continuum of care stemming from the following client sources: the CAMH Emergency Department (ED) triage; post-assessment or post-discharge by the ED; and post-discharge from the CAMH inpatient unit. Clients are unable to schedule appointments and access the clinic on a drop-in basis. The services included in BRDG are designed to ensure that clients a re bridged to other CAMH services, community or primary care providers and not lost to follow-up. When we analyzed the BRDG monthly reports, we learned that there is an increase in the total number of clients served yearly from 2017 to 2020 (Figure. 1, p < 0.05, except between 2020 and 2021; p >0.05). However, the difference between the number of new clients and total discharges has not followed the same upward trend as clients served each year (ANOVA p=0.04, but Tukey p>0.05 in all comparisons).
If we accept the increase of clients served yearly as a surrogate of the number of open episodes, the backlog in discharges was a natural outcome given the absence of a growth in discharge. During COVID, the backlog of clients worsened, further disrupting the flow of BRDG. The data, however, does not pinpoint the reason for the backlog. It should be clarified from Figure 1 that the discharge number for 2021 reflects a one-time focused effort put on discharge in the last three months of the year.
Project team
- Andres Kohan
- Dorottya Harangi
- Mona Irannejad
- Stephannie Jeanneret Manning
TRP supervisors
Project advisory committee
- Andrea Waddell
- Melissa Hiebert
- Olivier St-Cyr
See our community directory for more on committee members.
SPOT Concussion:Systems to Prevent Overlooking Teen Concussion
This study identifies barriers and facilitators to the use of paediatric concussion clinical practice guidelines among primary care providers in Toronto.
Background
Background: Evidence-based Clinical Practice Guidelines (CPGs) help improve the quality and consistency of care provided by healthcare professionals. However, despite the existence of multiple concussion-related CPGs, published studies suggest that CPG awareness and adherence is low for the management of paediatric concussion. Not using CPGs could contribute to missed diagnoses or the mismanagement of children at risk for persisting post-concussion symptoms (PPCS), such as anxiety and learning disabilities, which can last for years following injury. There is a need to increase the utilization of paediatric concussion CPGs by primary care providers (PCPs).
Objective: We aimed to improve the use of CPG guidelines among community-based PCPs in Toronto by first identifying the facilitators and barriers to the uptake of CPGs.
Methods: A qualitative descriptive study design was used. Family physicians, paediatricians, and nurse practitioners were recruited via purposive and snowball sampling. Semi-structured interviews were conducted online. A combination of deductive and inductive coding was used, and a reflexive thematic analysis process followed for data analysis.
Results: Eight participants met our eligibility criteria and were interviewed. Four overarching themes were identified:
- Diverse conceptualizations of concussion CPGs and their relevance
- Limited opportunities to learn about paediatric concussion
- The important role of intermediaries
- End-user needs remain unmet
Conclusion: Participants shared their perspectives, insights into their decision-making process, and helped identify the barriers and facilitators to the use of concussion CPGs. With this knowledge, custom strategies for community-based PCPs in Toronto could be created to improve concussion CPG uptake.
Project team
- Amelia Di Meo
- Bethany Tong
- Maryam Fereig
- Sarah Diaz
TRP supervisors
Project advisory committee
- Heather Boon
- Gabrielle Freire
- Charlene Welsh
See our community directory for more on committee members.