Ontario Survey Research Articles

The association between teacher distress and student mental health outcomes: a cross-sectional study using data from the school mental health survey

BackgroundFew studies have examined the inter-relationships between teacher and student mental health. We aimed to examine associations between teacher distress and student mental health difficulties and if student perceptions of school safety moderate these associations.MethodData from 23,568 students in grades 6–12 and 1,478 teachers from 268 schools participating in the School Mental Health Surveys in Ontario, Canada, were used. Three-level (student, classroom, school) multivariable linear regression models were fit to examine associations between teacher distress and student internalizing and externalizing symptoms by elementary (grades 6–8) and secondary (grades 9–12) school. Statistical interactions were used to evaluate effect modification.ResultsSmall but statistically significant, positive associations were found between teacher distress and internalizing (b = 0.02; 95% CI [0.01, 0.04], p < 0.05) and externalizing symptoms (b = 0.03; 95% CI [0.01, 0.05], p < 0.001) among elementary students only. Student perceptions of school safety moderated the association between teacher distress and externalizing symptoms among elementary students, whereby the positive association was magnified among students reporting lower school safety.ConclusionsFindings from this study highlight the importance of concurrently addressing the mental health needs of educators and students. School safety represents a modifiable target for prevention and intervention efforts in schools that could serve to promote student mental health and mitigate potential risk factors in schools.

Prevalence of a dual diagnosis of mental illness and substance use disorder in Ontario, Canada: a retrospective cohort study using linked administrative data

ObjectivePopulation-based prevalence estimates of co-occurring mental illness and substance use disorder (herein dual diagnosis) are scarce and derived from a single source (e.g., survey data) which may lead to underestimation of prevalence. We linked administrative data to a representative mental health survey in Ontario, Canada to estimate dual diagnosis prevalence using a data triangulation method. Approach We retrospectively linked the 2002 and 2012 Canadian Community Health Survey on Mental Health (CCHS-MH) to emergency department, inpatient hospital, and outpatient physician records in Ontario, Canada. Mental illness and substance use disorder were ascertained though self-report, Composite International Diagnostic Interview screening, and linked administrative health records. We estimated 1-year, 5-year, and lifetime prevalence of dual diagnosis. ResultsOf the CCHS-MH survey participants, 14,790 (99.8%) were included in the study. The 1-year, 5-year, and lifetime prevalence of dual diagnosis was 2.3%, 4.8%, and 9.8%, respectively, which attenuated to 2.1%, 4.1%, and 8.4%, respectively, when tobacco use disorder was removed from substance use disorder ascertainment. ConclusionDual diagnosis is more common in the general population than previously estimated. Considering barriers to accessing care for both mental illness and substance use disorders among people with dual diagnosis annually, our 5-year prevalence estimate is likely most informative for health system planning. ImplicationsIn the context of increased health burden, barriers to care access, and challenges to effective treatment associated with dual diagnosis, our findings present a case for increased investment in integrated models of mental healthcare and addiction medicine.

Pathogen presence, prevalence, and diversity in Ixodes scapularis and mammal hosts at their expanding northern range limits

With climate and land use changes, tick-borne pathogens are expected to become more widely distributed in Canada. Pathogen spread and transmission in this region is modulated by changes in the abundance and distribution of tick and host populations. Here, we assessed the relationships between pathogens detected in Ixodes scapularis and mammal hosts at sites of different levels of disease risk using data from summer field surveys in Ontario and Quebec, Canada. Generalized linear mixed models and ordinal logistic regressions were used to determine the influence of the abundance of I. scapularis and the abundance and diversity of mammal hosts on pathogen presence, prevalence, and diversity. We detected three pathogen species in I. scapularis and small mammals using nested PCRs, namely Borrelia burgdorferi sensu stricto, Babesia odocoilei, and Babesia microti. Depending on the analyzed pathogen, local infection prevalence ranged from 0% to 25.4% in questing ticks and from 0% to 16.7% in small mammal hosts. We detected B. odocoilei in localities beyond its known range limits in southeastern Quebec suggesting ongoing range expansion of this pathogen. Neither the abundance of I. scapularis nor the abundance and diversity of mammal hosts altered local pathogen presence and prevalence, contrary to expectations. However, mammal species richness was a key predictor of the number of pathogen species. Our study demonstrates the need for future surveillance efforts that test questing and feeding I. scapularis of all life stages, as well as their hosts to better determine the spread, transmission, and co-occurrence of tick-borne pathogens in Canada.

The Impact of the Covid-19 Pandemic on Assertive Community Treatment Team Functions, Clinical Services, and Observable Outcomes—A Provincial Survey in Ontario, Canada

Assertive Community Treatment (ACT) teams provide the most intensive care for patients with serious mental illness. This online study surveyed the 88 ACT and Flexible ACT (FACT) teams in Ontario, Canada (144/232 surveys, 62.1%) during the height of Covid-19 in 2021, and qualitative thematic analysis on impact of team function and patient outcome showed challenges of teams switching to virtual care, reduced psychosocial services, division to smaller groups, staff redeployment, having unequal compensations, and exacerbated regional differences; there were also increased patient stress, loneliness, hospital and ER visits, substance use and related deaths, and police/crisis team involvement. There was limited morbidity related to actual Covid-19; and positive adaptations included observed independence and resilience, increased interdependence with community partners, and new communication formats.

Physician ratings of physician assistant competencies and their experiences and satisfaction working with physician assistants: Results from the supervising physician survey in Ontario, Canada.

Physician Assistants (PAs) are a relatively new addition to the Ontario healthcare system. To understand the impact of the PA role, this study investigated supervising physician satisfaction and perception of PA roles, interprofessional team integration, pandemic supports, and barriers and enablers to PA employment. A web-based survey was conducted of 118 physician supervisors of Ontario PA education program alumni. PAs were employed in a variety of community and hospital settings. In addition to patient care, PAs were involved teaching (65.6%), quality improvement (52.7%), and mentorship (40.0%). Overall, 92.9% of physicians indicated they were satisfied with their PAs. Important barriers to hiring PAs included maintaining PA salaries, billing limitations, and PA shortages. PAs have established themselves as valuable and competent members of healthcare teams. By continuing to explore the enablers and barriers to PA employment from the physician perspective, health leaders can continue to optimize and support role integration.

Pediatricians' perceptions, practices, and barriers regarding COVID-19 vaccine for children: A cross-sectional survey in Ontario, Canada.

SARS-CoV-2 vaccination of all age-eligible populations is an important part of the COVID-19 pandemic response. In Ontario, vaccination coverage in 5-to-11-year-old children has remained lower than in other age groups. We sought to understand pediatricians' perception, practices, and barriers to SARS-CoV-2 vaccination in children, particularly children aged 5-to-11years, to inform interventions and promote capacity of pediatricians as vaccinators and vaccination promoters. This is a descriptive, cross-sectional study consisting of an online self-administered questionnaire distributed to 1,313 pediatricians in Ontario. Descriptive statistics, including Chi-square or Fisher's exact tests, were performed. In total, 152 Pediatricians responded (11.6% response rate), from February 17, 2022 to March 17, 2022. 78% of respondents were general pediatricians and 22% were pediatric subspecialists. Median years of practice was 17 (8-31), with 68% female, 32% male. Most pediatricians thought it was unlikely that children aged 5-to-11years would become seriously ill from acute COVID-19 caused by Delta (66%) or Omicron (80%). 92% were very likely to recommend the COVID-19 vaccine for children aged 5-to-11years. COVID-19 vaccine was perceived as safe, with higher safety perception in children aged 5-to-11 compared to 12-to-17years (p<0.0001). COVID-19 vaccines were thought to be effective in reducing hospitalization or severe illness, and reducing SARS-CoV-2 infection, with higher perceived effectiveness against Delta compared to Omicron (p<0.0001). 97% felt confident counselling caregivers of children aged 5-to-11years on the COVID-19 vaccine. Few pediatricians did not feel confident in accessing resources for health professionals (6%) or for patients/caregivers (12%). Most surveyed pediatricians were very likely to recommend COVID-19 vaccination for children aged 5-to-11-years, perceived COVID-19 vaccines as safe and effective, and felt confident in their COVID-19 vaccine counselling for children aged 5-to-11years. However, there remains areas for further training and capacity development.

Chronic Exposure to Fine Particulate Matter Increases Mortality Through Pathways of Metabolic and Cardiovascular Disease: Insights From a Large Mediation Analysis.

Background Long-term exposure to outdoor fine particulate matter (PM2.5) is the leading environmental risk factor for premature mortality worldwide. Characterizing important pathways through which PM2.5 increases individuals' mortality risk can clarify the PM2.5-mortality relationship and identify possible points of interventions. Recent evidence has linked PM2.5 to the onset of diabetes and cardiovascular disease, but to what extent these associations contribute to the effect of PM2.5 on mortality remains poorly understood. Methods and Results We conducted a population-based cohort study to investigate how the effect of PM2.5 on nonaccidental mortality is mediated by its impacts on incident diabetes, acute myocardial infarction, and stroke. Our study population comprised ≈200 000 individuals aged 20 to 90 years who participated in population-based health surveys in Ontario, Canada, from 1996 to 2014. Follow-up extended until December 2017. Using causal mediation analyses with Aalen additive hazards models, we decomposed the total effect of PM2.5 on mortality into a direct effect and several path-specific indirect effects mediated by diabetes, each cardiovascular event, or both combined. A series of sensitivity analyses were also conducted. After adjusting for various individual- and neighborhood-level covariates, we estimated that for every 1000 adults, each 10 μg/m3 increase in PM2.5 was associated with ≈2 incident cases of diabetes, ≈1 major cardiovascular event (acute myocardial infarction and stroke combined), and ≈2 deaths annually. Among PM2.5-related deaths, 31.7% (95% CI, 17.2%-53.2%) were attributable to diabetes and major cardiovascular events in relation to PM2.5. Specifically, 4.5% were explained by PM2.5-induced diabetes, 22.8% by PM2.5-induced major cardiovascular events, and 4.5% through their interaction. Conclusions This study suggests that a significant portion of the estimated effect of long-term exposure to PM2.5 on deaths can be attributed to its effect on diabetes and cardiovascular diseases, highlighting the significance of PM2.5 on deteriorating cardiovascular health. Our findings should raise awareness among professionals that improving metabolic and cardiovascular health may reduce mortality burden in areas with higher exposure to air pollution.

Measuring the attitudes of midwives toward sexual and gender minority clients: Results from a Cross-Sectional survey in Ontario.

In Canada, Ontario midwives provide care to sexual and gender minority (SGM) people. Published literature shows how midwives' attitudes shape the experiences of lesbians, but research examining midwives' attitudes toward SGM people is lacking. Our study measured the attitudes of Ontario midwives toward SGM clients, hypothesizing that attitudes would be positive overall and that there would be no difference in attitudes across practice settings. Paper surveys (n=926) with an option to respond online were sent to Ontario midwifery practices. We measured midwives' attitudes toward sexual minorities (11 questions, scores ranged from 11 to 55) and gender minorities (9 questions, scores ranged from 9 to 45), with higher scores indicating more positive attitudes. Overall and subgroup analyses were performed. The 268 completed surveys indicated that midwives' attitudes were positive toward both sexual (mean score 49.2, maximum possible score of 55, ie, 89.4%) and gender minorities (mean score 38.9, maximum possible score of 45, ie, 86.4%). Analyses showed that attitudes toward SGM were associated with midwives' sexual identity and route of entry into the profession (ie, university-based vs bridging programs), but not practice setting. Although attitudes of this subset of midwives toward SGM clients were positive, volunteer bias could account for this finding since 32.6% of respondents identified as sexual minorities. Since the attitudes of midwives who entered the profession through the university-based education program were significantly more positive than those who entered through international bridging programs, future research should examine how SGM-related content is integrated into midwifery education and training curricula.

Sociodemographic differences in patient experience with primary care during COVID-19: results from a cross-sectional survey in Ontario, Canada

PurposeWe sought to understand patients’ care-seeking behaviours early in the pandemic, their use and views of different virtual care modalities, and whether these differed by sociodemographic factors.MethodsWe conducted a multisite...

Addressing Risk Perceptions of Low-Dose Radiation Exposure.

Concern over low-dose radiation (LDR) (exposure of less than 100 milligray (mGy)) is resulting in people refusing diagnostic procedures and medical treatment 1 and also inhibiting revision of the linear no-threshold (LNT) assumption that informs much of science policy. This article reviews representative surveys in Ontario and Saskatchewan and focus groups conducted with science and policy stakeholders in addressing how the public and policy stakeholders understand issues of exposure to LDR and how policy issues can be addressed.Research results from focus groups demonstrated that policy stakeholders are knowledgeable about issues surrounding the public and perceptions about LDR and implications for policy consistent with LDR literature. Participants understood that the challenge went beyond providing more education about LDR and issues of emotions and biases must be addressed. This research resulted in rich suggestions for public communication and engagement surrounding LDR and a process for addressing the issue of the LNT.

Adapting Cognitive Remediation Group Therapy as an Online or Hybrid Intervention for People Aging With HIV and Cognitive Concerns: Focus Group Protocol

Cognitive impairment is a significant health issue for people aging with HIV/AIDS. Cognitive challenges can include forgetfulness, trouble concentrating, and increasing struggles to learn new skills, all of which contribute to poorer mental health and decreased quality of life. Although there is no specific drug therapy that can reverse the brain impairment, group therapies may help people aging with HIV and cognitive challenges to better cope with their symptoms when combined with their usual medical treatment and follow-up. This community-based study will involve peer-led focus groups to discuss cognitive remediation group therapy – a combination of mindfulness-based stress reduction and brain training activities tested in a pilot randomized, controlled trial – as an in-person intervention for people aging with HIV in 2019. Via a brief demographic survey and technology-mediated focus groups ( n = 40) in Ontario and Saskatchewan, we will determine how the intervention could be adapted in an online or hybrid format considering the ongoing COVID-19 pandemic. Content analysis will be employed whereby a team of independent coders will code the focus group transcripts in line with the co-design framework and “Double Diamond” model of developing interventions, including intervention structure, content, and mode of delivery. Given the aging of the HIV population in Canada, increasing support will be required in addition to medical care to improve quality of life, and proactively address concerns about cognition. This protocol provides a roadmap for adapting in-person psychosocial interventions using community-based and technology-mediated methods.

Incentivizing the future adoption of best management practices on agricultural land to protect water resources: The role of past participation and experiences

Best Management Practices (BMPs) incentive programs have been introduced to protect agricultural land and reduce nutrient runoff in watersheds. However, their voluntary nature has not led to the expected high participation rates. We examine influencing factors and underlying drivers that are associated with BMP adoption and farmer preferences for specific BMPs. Data are collected through an online survey in Ontario, Canada in 2019. A binary logit model is estimated to explain current participation in BMP schemes and a multinomial logit model to predict preferences for future BMP uptake. Results show that a mix of farmer and farm characteristics and environmental attitudes explain both current participation in BMP schemes and the likelihood of adopting a future BMP. Farmers tend to endorse a BMP if they currently implement that BMP. The findings furthermore suggest that increasing farmers' environmental awareness and sharing positive BMP experiences with other farmers may help expand future BMP adoption in Ontario.

Primary care bonus payments and patient-reported access in urban Ontario: a cross-sectional study.

Background:Rurality strongly correlates with higher pay-for-performance access bonuses, despite higher emergency department use and fewer primary care services than in urban settings. We sought to evaluate the relation between patient-reported access to primary care and access bonus payments in urban settings.Methods:We conducted a cross-sectional, secondary data analysis using Ontario survey and health administrative data from 2013 to 2017. We used administrative data to calculate annual access bonuses for eligible urban family physicians. We linked this payment data to adult (≥ 16 yr) patient data from the Health Care Experiences Survey to examine the relation between access bonus achievement (in quintiles of the proportion of bonus achieved, from lowest [Q1, reference category] to highest [Q5]) and 4 patient-reported access outcomes. The average survey response rate to the patient survey during the study period was 51%. We stratified urban geography into large, medium and small settings. In a multilevel regression model, we adjusted for patient-, physician- and practice-level covariates. We tested linear trends, adjusted for clustering, for each outcome.Results:We linked 18 893 respondents to 3940 physicians in 414 bonus-eligible practices. Physicians in small urban settings earned the highest proportion of their maximum potential access bonuses. Access bonus achievement was positively associated with telephone access (Q2 odds ratio [OR] 1.18, 95% confidence interval [CI] 0.98–1.42; Q3 OR 1.34, 95% CI 1.10–1.63; Q4 OR 1.46, 95% CI 1.19–1.79; Q5 OR 1.87, 95% CI 1.50–2.33), after hours access (Q2 OR 1.26, 95% CI 1.09–1.47; Q3 OR 1.46, 95% CI 1.23–1.74; Q4 OR 1.77, 95% CI 1.46–2.15; Q5 OR 1.88, 95% CI 1.52–2.32), wait time for care (Q2 OR 1.01, 95% CI 0.85–1.20; Q3 OR 1.17, 95% CI 0.97–1.41; Q4 OR 1.27, 95% CI 1.05–1.55; Q5 OR 1.63, 95% CI 1.32–2.00) and timeliness (Q2 OR 1.29, 95% CI 0.98–1.69; Q3 OR 1.29, 95% CI 0.94–1.77; Q4 OR 1.58, 95% CI 1.16–2.13; Q5 OR 1.98, 95% CI 1.38–2.82). When stratified by geography, we observed several of these associations in large urban settings, but not in small urban settings. Trend tests were statistically significant for all 4 outcomes.Interpretation:Although the access bonus correlated with access in larger urban settings, it did not in smaller settings, aligning with previous research questioning its utility in smaller geographies. The access bonus may benefit from a redesign that considers geography and patient experience.

Are school-based measures of walkability and greenness associated with modes of commuting to school? Findings from a student survey in Ontario, Canada.

In Canada, students are increasingly reliant on motorized vehicles to commute to school, and few meet the recommended overall physical activity guidelines. Infrastructure and built environments around schools may promote active commuting to and from school, thereby increasing physical activity. To date, few Canadian studies have examined this research question. This study is a cross-sectional analysis of 11,006 students, aged 11-20, who participated in the 2016/2017 Ontario Student Drug Use and Health Survey. The remote sensing-derived Normalized Difference Vegetation Index (NDVI), at a buffer of 500m from the schools' locations, was used to characterize greenness, while the 2016 Canadian Active Living Environments (Can-ALE) measure was used for walkability. Students were asked about their mode of regular commuting to school, and to provide information on several socio-demographic variables. Multivariable logistic regression models were used to quantify associations between active commuting and greenness and the Can-ALE. The resulting odds ratios, and their 95% confidence intervals, were adjusted for a series of risk factors that were collected from the survey. Overall, 21% of students reported active commuting (biking or walking) to school, and this prevalence decreased with increasing age. Students whose schools had higher Can-ALE scores were more likely to be active commuters. Specifically, the adjusted odds ratio (OR) of being an active commuter for schools in the highest quartile of the Can-ALE was 2.11 (95% CI = 1.64, 2.72) when compared with those in the lowest. For children, aged 11-14years, who attended schools in high dwelling density areas, a higher odds of active commuting was observed among those in the upper quartile of greenness relative to the lowest (OR = 1.41; 95% CI = 0.92, 2.15). In contrast, for lower dwelling density areas, greenness was inversely associated with active commuting across all ages. Our findings suggest that students attending schools with higher Can-ALE scores are more likely to actively commute to school, and that positive impacts of greenness on active commuting are evident only in younger children in more densely populated areas. Future studies should collect more detailed data on residential measures of the built environment, safety, distance between home and school, and mixed modes of commuting behaviours.

Canadian Registered Midwives' Experiences With Nipple Stimulation: An Exploratory Survey in British Columbia and Ontario.

The objective of our study was to explore Canadian registered midwives' (RMs') experiences with nipple stimulation. An online survey was distributed to practising RMs in British Columbia and Ontario. In total 350 RMs completed the survey. Of these, 154 (44%) practised in British Columbia and 196 (56%) practised in Ontario. This represents a response rate of 53.3% and 20.6% in B.C. and Ontario, respectively. Ninety-six percent of those surveyed (337 RMs) reported having advised clients to use nipple stimulation as a means of releasing oxytocin, and 80% (267 RMs) considered nipple stimulation to be effective. Respondents reported 926 protocols for nipple stimulation. The most common indication for nipple stimulation was for labour augmentation, used by 92% of respondents. Nipple stimulation is widely used by RMs practising in British Columbia and Ontario. Survey respondents believed it to be effective and beneficial in mitigating the need for synthetic oxytocin. Survey results showed that the most common indication for nipple stimulation is labour augmentation. Future research should prospectively address the safety and effectiveness of this non-medical method of labour augmentation.

Examining the effects of low back pain and mental health symptoms on healthcare utilisation and costs: a protocol for a population-based cohort study

IntroductionLow back pain (LBP) is a leading cause of disability associated with high healthcare utilisation and costs. Mental health symptoms are negative prognostic factors for LBP recovery; however, no population-based...

Structured and unstructured citizen science: Seven decades of expanding bird populations in central Ontario, Canada

Citizens’ observations of wildlife offer a wealth of information. Such data, however, may be prone to biases or inaccuracies — in particular, the over-reporting of novel species and under-reporting of common or mundane species. Few studies have assessed the relationship between unstructured and structured observations using long-term data. We compared 69 years of voluntary bird sightings, recorded in the regular publication of Peterborough Field Naturalists (PFN), 1948–2016, to systematic Christmas Bird Counts (CBC; during winter) and Breeding Bird Surveys (BBS; during spring) in central Ontario, Canada. We focused on seven species that had expanded their ranges into the area: Northern Cardinal (Cardinalis cardinalis), House Finch (Haemorhous mexicanus), Purple Finch (Haemorhous purpureus), Red-bellied Woodpecker (Melanerpes carolinus), Wild Turkey (Meleagris gallopavo), Canada Goose (Branta canadensis), and American Robin (Turdus migratorius). For each species, we compared the first record, the annual number of sightings, and the annual relative abundance from the PFN to the first record and annual relative abundance in the CBC and BBS. We anticipated that naturalists’ accounts would be more sensitive to the arrival of novel species but would underestimate abundance as the species became common.In general, our results agreed with these predictions. In 11 of 12 cases, the naturalists detected a species well in advance of the CBC and BBS — on average by 1½ decades (range: 5–33 years). The correlations in bird abundance between unstructured (PFN) and structured (CBC and BBS) data were variable; most were weak and negative. We found significant negative correlations for the two most common species, Northern Cardinal (winter) and House Finch (spring), as well as for Wild Turkey (winter), and a positive correlation for the rarest species, the Red-bellied Woodpecker (spring). We surmise that novelty underlies these results — that rarity increases the likelihood of reporting by non-professionals. We conclude that unstructured observations are valuable in detecting novel species, but they may be inconsistent, even inverse, indicators of the abundance of expanding species, once established.

Prevalence of dry eye disease in Ontario, Canada: A population-based survey

PurposePopulation-based cross-sectional survey in Ontario to estimate the 2016 prevalence of dry eye disease (DED) and associated risk factors among adults in Canada. MethodsWe emailed the 5-Item Dry Eye Questionnaire (DEQ-5) to 124,469 Ontario adults (age ≥18 years) in the IQVIA E360 database, March–April 2017. Inclusion criteria were: ≥2 visits to an Ontario based clinic, ≥1 visits in the 1 year before the study; database record with email. DED was defined as a DEQ-5 score of >6/22. The crude prevalence by age/sex of the Ontario sample was adjusted to the 2016 Canadian population (mean age 41.0 years, 51% female). Significance of DED risk factors (age, sex, selected diseases/medical conditions and medications) was evaluated by logistic regression analysis. ResultsOf the 5163 (4.1%) patients who completed the survey (59.5% female, median age, 46 years; 40.4% male, 56 years), 1135 respondents reported DED. Prevalence increased with age (p < 0.05) and was highest among those aged 55–64 years (24.7%; 95% CI, 22.1–27.3%) and lowest among those aged 25–34 years (18.4%; 95% CI, 15.9–21.0%). Prevalence was significantly higher (p < 0.001) among women (24.7%; 95% CI, 23.2–26.2%) than men (18.0%; 95% CI, 16.4–19.7%). Other risk factors were not significant. The age-/sex-adjusted Canadian DED prevalence estimate from this sample was 21.3% (95% CI, 19.8–23.2%), corresponding to ∼6.3 million people. ConclusionsBased on the Ontario sample, we estimate that >6 million Canadian adults may have DED, and that older people and females are more likely to be affected.

Using the CollaboraKTion framework to report on primary care practice recruitment and data collection: costs and successes in a cross-sectional practice-based survey in British Columbia, Ontario, and Nova Scotia, Canada

BackgroundAcross Canada and internationally we have poor infrastructure to regularly collect survey data from primary care practices to supplement data from chart audits and physician billings. The purpose of this work is to: 1) examine the variable costs for carrying out primary care practice-based surveys and 2) share lessons learned about the level of engagement required for recruitment of practices in primary care.MethodsThis work was part of a larger study, TRANSFORMATION that collected data from three provincial study sites in Canada. We report here on practice-based engagement. Surveys were administered to providers, organizational practice leads, and up to 20 patients from each participating provider. We used the CollaboraKTion framework to report on our recruitment and engagement strategies for the survey work. Data were derived from qualitative sources, including study team meeting minutes, memos/notes from survey administrators regarding their interactions with practice staff, and patients and stakeholder meeting minutes. Quantitative data were derived from spreadsheets tracking numbers for participant eligibility, responses, and completions and from time and cost tracking for patient survey administration.ResultsA total of 87 practices participated in the study (n = 22 in BC; n = 26 in ON; n = 39 in NS). The first three of five CollaboraKTion activities, Contacting and Connecting, Deepening Understandings, and Adapting and Applying the Knowledge Base, and their associated processes were most pertinent to our recruitment and data collection. Practice participation rates were low but similar, averaging 36% across study sites, and completion rates were high (99%). Patient completion rates were similarly high (99%), though participation rates in BC were substantially lower than the other sites. Recruitment and data collection costs varied with the cost per practice ranging from $1503 to $1792.ConclusionsA comprehensive data collection system in primary care is possible to achieve with partnerships that balance researcher, clinical, and policy maker contexts. Engaging practices as valued community members and independent business owners requires significant time, and financial and human resources. An integrated knowledge translation and exchange approach provides a foundation for continued dialogue, exchange of ideas, use of the information produced, and recognises recruitment as part of an ongoing cycle.

Assessing Morality: The Ontario Provincial Survey of 1896

In this essay the published results of the 1896 Ontario survey into the moral standing of teachers and pupils are analyzed. The commentaries of school inspectors are used to make connections between morality and the formation of moral character. A distinction between abstract moral obligations and concrete moral customs provides a framework for understanding the moral activity under investigation. Remarks by inspectors indicate the manner in which the conception of morality was perceived and provide the essential content of the inquiry