What else could healthcare providers and educators be doing to decrease preventable chronic illnesses and improve the health of Manitoban patients? That’s the question that Dr. Alan Katz, associate director of the Manitoba Centre for Health Policy, hopes to answer with his ongoing research on primary prevention in healthcare.
Katz’ latest research comes in response to a report published in 2010 entitled Making the Case for Primary Prevention: An Economic Analysis of Risk Factors in Manitoba. According to the report, “[the] three biggest factors substantially associated with chronic disease—tobacco smoking, physical inactivity, and obesity—have high prevalence in Manitoba,” and are creating massive economic strain on the Manitoban healthcare system to the tune of an estimated $1.62 billion in 2008.
The report estimates that 55 per cent of Manitobans are obese or overweight, 45 per cent are inactive, and 27 per cent are smokers. The report also projects that if the proportion of Manitoba’s population remains at 2008 levels, the economic burden on the healthcare system could reach as high as $4.7 billion.
In response to the findings, the Manitoba Health Research Council named Katz the province’s first ever Primary Prevention Research Chair in 2012, providing $500,000 in funding for research over five years.
Dr. Katz has assembled a seven-person team that includes four University of Manitoba graduate students, each bringing a wealth of knowledge and experience from their respective fields. The team of interdisciplinary researchers is focusing on three key factors to preventative healthcare: physical activity, mental wellness and reducing tobacco usage.
“We have a very unique group,” said Gayle Halas, a research associate in the faculty of family medicine. Halas brings experience in dental hygiene and six years spent working in the faculty of dentistry between 2000 and 2006 to the research team.
“Being an oral healthcare provider as my background, I’ve always had a unique interest in tobacco, so that’s the area of this project that I’m most focused on.”
Pam Werner has been a member of the faculty of occupational therapy since 1991, and is currently pursuing a PhD in interdisciplinary studies, combining nursing, occupational therapy, and education.
“My background in terms of occupational therapy was in mental health, so that’s a big part of why I came onto this team,” says Werner, who is still working full-time, teaching, and doing research of her own.
“I think they thought I might bring something from that perspective, from an occupation therapy perspective.”
Jennifer Enns is pursuing her PhD in the department of physiology & pathophysiology within the faculty of health sciences. Her research explores the role of functional foods in metabolic and cardiovascular disease, with a focus on canola oil, a Manitoba crop high in monounsaturated and omega-3 fatty acids, and the potential benefits it may have for obesity and peripheral arterial disease.
Enns began working with Katz as a research assistant in family medicine in 2010 while completing her MSc in physiology. After a hiatus through the fall and winter of 2013, Enns rejoined Katz’ research team in May.
Rounding out the grad students is Leah Goertzen. Goertzen is pursuing her Master of Arts in the faculty of kinesiology and recreational management, and is focusing her research on exploring sociocultural factors impacting new immigrant women’s physical activity within the first five years of arriving in Canada.
“My undergrad was in community development, so for me, I don’t come from primary care or the faculty of medicine at all, so I’ve had experience within the community at large,” said Goertzen.
“When I think of interventions, I think of that population and the work that’s done out there. Healthcare providers are often seen as what’s happening in the hospital, but really, community development workers are also providing health services in their own way.”
The team is passionate about the work they do, and hope to provide valuable information to help improve the health and wellness of Manitobans.
“These three areas, if you think about the things you can control in your life, they’re huge areas that have huge impacts on health,” said Werner.
One of the first things that Katz decided to do is a scoping review, a relatively new type of review methodology that has been adapted for the three topic areas of interest. A scoping review requires combing through data and evidence collected on a specific topic, determining what is known and what is unknown, and analyzing the research already conducted to provide greater clarity on overarching trends in the field.
“It’s sort of a novel method and it’s designed to look at the breadth instead of looking at things very narrowly,” says Halas, who used her focus, tobacco use, to illustrate the point.
“So much of the research has been around cessation,” said Halas, referring to smoking-related research.“Let’s look at maybe what’s some of the more preventative measures that can happen. What about second-hand exposure? What are some of those unique angles like workplaces, schools, those kind of things that perhaps we could do more with?”
The team has already begun presenting pieces of their research review, with more presentations slated for the fall.
“Aside from doing the actual scoping review, we’ve each developed a protocol paper and are working on a discussion paper about the methodology,” said Goertzen.
Participating in a Primary Prevention Research Forum on Feb. 5, 2014, Katz spoke about his team and the research they are conducting.
“We’ve got a great interdisciplinary team with two PhD students and two Masters students, and a couple of us who are fairly experienced researchers,” said Katz.
“We’ve done some really exciting work by coming together each week and learning from each other, and from the process. One of the dangers of using a data synthesis group to give you a data synthesis—or wrapped up in a bow—is that you don’t go through the learning process that comes from that.”
“We’re talking about complex issues, and to answer these issues we need the integration in terms of developing research teams. [.. .] We can’t do this in isolation, I believe. That’s a key lesson that I’ve felt from the beginning, that we do need interdisciplinary teams to work together.”