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Developing a National Family Planning Primary Healthcare Research Program : Opportunities and Priorities… Norman, Wendy V.; Dunn, Sheila; Guilbert, Edith; Soon, Judith Alice; Hutchison, Penelope 2011

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Developing a National Family Planning  Primary Healthcare Research ProgramOpportunities and Priorities  Identified Through Stakeholder  and Expert ConsultationsFall 2011Thank you to our sponsorsSuggested citation for this work: Norman WV, Dunn S, Guilbert E, Soon J, Hutchison P. , Developing a national family planning primary healthcare research program: opportunities and priorities identified through stakeholder and expert consultations. March 2012. Available at: www.cart-grac.ca and  http://whri.org/our-research/family-planning.aspx.Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram iiiExecutive SummaryTo develop a foundation for a national family planning research network, a core research team conducted several initiatives throughout the fall of 2011. Meetings with health system decision makers in public health and health services delivery from government, public and not-for-profit sectors across the nation were carried out to capture perceived gaps and opportunities as seen by knowledge users. As well, key informant interviews, and surveys among national organizations representing vulnerable populations and those representing health care professionals were conducted, and used to inform discussions at planning meetings with nationally representative health professionals and interdisciplinary academic researchers. Innovative models and important gaps emerging from each of these activities have been used to identify priorities for a programmatic community-based primary healthcare family planning research and researcher training agenda that could advance access to optimal contraception and abortion knowledge and services.The aim of this work is to improve the health of Canadian women and families by reducing unintended pregnancies and improving recognition of optimal pregnancy timing, so that women are able to achieve the healthiest pregnancies. Our goal is to undertake primary healthcare family planning research that will lead to improvements in equitable access to high quality family planning knowledge, services and methods, particularly among vulnerable women and families throughout Canada. Initiatives described here include: •  National mixed methods surveys of stakeholders  and primary healthcare clinicians •  Expert Interviews with key stakeholders •  A “Network Launch” consultation forum with  Clinical Service providers  •  A planning meeting with key decision makers and interdisciplinary academic researchers to establish research program priorities This report will largely detail the latter of these activities, with findings from the former activities provided in  the appendices.On October 25, 2011, the CART-GRAC Contraception Access Research Team / Groupe de Recherche sur l’Accessibilité à la Contraception convened the Setting National Family Planning Health Service Goals core planning meeting to guide Canada’s first national family planning research collaboration.More than two dozen health policy leaders, hospital administrators, health economists, social scientists, population health experts, computer scientists, primary care health professionals, community group representatives and interdisciplinary researchers from across Canada came together in Toronto, Canada to review results from surveys, expert interviews and consultations. This meeting fostered a sharing of ideas, identification of priorities, and agreement on best approaches for a robust program of national family planning research.Six themes emerged from the day’s discussions with allied priority issues and ideas for the CART-GRAC core team to consider when focusing their efforts as the initiative moves forward. (See chart, next page.)The CART-GRAC core research team will use the themes and ideas generated by these stakeholder and expert consultation initiatives, and the information from the mixed methods studies (appended) to inform development of an innovative programmatic approach to research and a researcher training program. The CART-GRAC initiative heralds a bold new frontier for family planning research and collaboration in Canada. It marks the first-ever national network of interdisciplinary, cross-sectorial,  interprofessional family planning researchers and stakeholders working  in concert with public health and health system delivery leaders to share ideas and lead innovation for the benefit of Canadian women and families.iv Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram1.  Develop a comprehensive research and evaluation framework, methods and approach2.  Improve understanding of, and solutions to, barriers to access 3.  Improve provider cultural competencies through education 4.  Inform understanding of needs and behaviours of high need segments of  the population 5.  Develop an effective system design and delivery 6.  Understand the broad sociological contextAdvancing access to optimal  family planning knowledge  and servicesCART-GRAC Summary Themes– 1.1  Multiples stakeholder engagement approach– 1.2  Data and indicators to measure access, cost-effectiveness, behaviours– 1.3  Methods: surveillance, national population survey, build on novel models of care, i.e. “multiply pockets of brilliance” (learning) – 1.4  Consider/assess opportunities for intersectionality across marginalized statuses– 2.1  Focus on marginalized populations: low socio-economic status (SES), rural/remote, immigrants, First Nations, disabled, lesbian, gay, bisexual, transgender and questioning (LGBTQ) – 2.2  Access barriers: economic (cost to person and provider), psychological, roles (e.g., parents) – 2.3  Provider attitudes, norms and knowledge – 2.4  Continuity of utilization of contraceptives in women who experience marginalization – 2.5  Access to skilled professional in acceptable time frame in an acceptable location– 3.1  Understand discrimination, women centred care, disabilities, immigrants, LGBTQ, poverty, violence– 3.2  Develop training and education models including new technologies, telehealth, Apps, Serious Games, etc.  – 3.3  Strengthen networks and community of practice for providers – 4.1  Violence and coercion: trauma-informed contraceptive care, sexual power, accessibility – 4.2  Marginalized populations: immigrants, transgendered, disabled, teens, impoverished– 4.3  Public education: role of social media, role of school system, role of community and social service agencies– 4.4  Continuity of utilization of contraceptives for women who experience marginalization – barriers to initiation, barriers to continuity, user perceptions of quality– 4.5  Culturally competent education for service users and adult women, teens, and men– 4.6  Quality of information: unbiased, medically accurate, Canadian, accessible, inclusive– 5.1  Service delivery: scope of practice and task sharing/shifting, continuity, coordination, confidentiality– 5.2  System design: abortion public system, shared care model, standards, indicators, policies and policy enablers– 6.1  Migration experience of immigrants, colonization history of  First Nations– 6.2   Stigmas e.g., towards sexuality and abortion– 6.3  Design system to consider evidence based, context sensitive,  central vs local, define success and develop outcome indicatorsGoAl THEMES SPECIFIC IDEASCart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram vTable of ContentsExECuTIvE SummaRy IIIaCkNOwlEDgEmENTS vISETTINg PRIORITIES FOR a NaTIONal RESEaRCH PROgRam  11.  uNDERSTaNDINg FamIly PlaNNINg gaPS aND OPPORTuNITIES 2A.  Forming a Canadian Contraception Access Research Network 2B.  Meeting Global Family Planning Needs 3C.  National Scan: Examples of Canadian Family Planning Research 5D. Stakeholder Scan 72. SETTINg PRIORITIES, BuIlDINg SOluTIONS 10A. Summary Themes 10B.  Approach to the Research Program 14C. Pathways to Progress 14aPPENDICES 16aPPENDIx a: CORE RESEaRCH TEam PlaNNINg mEETINg agENDa 17aPPENDIx B: CaRT-gRaC CONFERENCE PaRTICIPaNTS, OCTOBER 25, 2011, TORONTO, ONTaRIO  18aPPENDIx C: STakEHOlDER SCaN 201. National Stakeholder and Expert Interviews 202. Clinician and Social Scientist Collaborators 223.  National Stakeholder Surveys: Canadian Contraceptive Access Survey (CCAS) 23aPPENDIx D: COllaBORaTION wITH gRaND 31vi Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGramAcknowledgementsThe efforts and commitment of numerous individuals and organizations made the CART-GRAC: Setting National Family Planning Health Service Goals planning meeting possible. Organizations generously providing funding for these planning activities include:• Canadian Institutes of Health Research (CIHR)• University of British Columbia (UBC), Department of Family Practice• BC Women’s Hospital and Health Centre (BC Women’s) •  The GRAND (Graphics, Animation and New Media) NSERC funded Network of Centers of Excellence• Women’s College Hospital, Toronto, Ontario• Institut national de santé publique du Québec (INSPQ)• University of TorontoCART-GRAC team leads Dr. Wendy Norman and Dr. Sheila Dunn, and with the expert advice and collaboration of Dr. Edith Guilbert of the INSPQ, extend their thanks to the following individuals for their assistance: • Janet Brown (Facilitator)• Penelope Hutchison (Writer)• Jessica Ferne (Note-Taker)• Jane Gautier (Arrangements for Stakeholder Interviews)Most importantly, CART-GRAC wishes to thank the policy makers, health system leaders, health  care providers, administrators, computer scientists, researchers and others who attended the October 25, 2011 planning session, and the October 23 network launch session and the hundreds of health professionals, advocates, national representative organization leaders and citizens across the country who contributed their experiences and opinions in the stakeholder surveys. Their energy, enthusiasm and thoughtful, considered suggestions have provided the foundational elements on which to build the first national Canadian family planning research collaboration. Wendy norman, mD, mHsc  Clinical Professor, Dept. of Family Practice and Associate Member, School of Population & Public Health, Faculty of Medicine, University of British Columbia, Principal Investigator, Women’s Health Research Institute, British Columbia Women’s Hospital & Health Centre,  Vancouver, British Columbia     sheila Dunn, mD, msc Associate Professor and Clinician Investigator Dept. of Family and Community Medicine Faculty of Medicine, University of Toronto, andResearch Director,  Department of Family and Community Medicine,  Women’s College Hospital, Toronto, OntarioCart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram 1Setting Priorities for a National Research Program CART-GRAC’s aim  is to reduce unintended pregnancies and increase awareness of optimal pregnancy timing and thus improve health, particularly among vulnerable groups of Canadian women and their families. More than 25 stakeholders from across Canada came together in Toronto, Canada on October 25, 2011, to establish key priorities for an inaugural national family planning research team. The Contraception Access Research Team (CART)/Groupe de Recherche sur L’Accessibilite a la Contraception (GRAC) planning meeting saw health policy leaders, health system decision makers, health economists, human-computer interaction scientists, community group representatives, primary care health professionals and interdisciplinary researchers evaluate broad stakeholder input from surveys and interviews, and bring forward their best ideas to establish priorities.(See Appendices A and B for the day’s agenda and a list of participants and participant organizations.)Session objectives were to: •  Understand the current state of family planning challenges in Canada, and exchange ideas on mechanisms to address these. •  Discuss successful models of family planning health services, and potential innovations that could be shared between provinces to enhance community-based primary healthcare access and knowledge translation nationally. •  Explore optimal team, collaborator and network composition considering public, private, not-for-profit and academic sectors; key knowledge users and health policy decision makers; a broad range of health, social science and communication disciplines; and including representation from among marginalized and vulnerable populations. •  Discuss how family planning research may inform government health care decision makers, facilitate knowledge translation and enhance uptake of research findings into a post research phase.The first half of the day gave participants an overview of current family planning gaps and opportunities – moving from global family planning needs to the state of Canadian family planning health services research, to a summary of consultations with key national stakeholders on facilitators and barriers to effective contraception and abortion access.The facilitated afternoon sessions synthesized ideas gleaned from the morning and participant experience and perspectives to identify key priorities for research themes to advance access to optimal family planning knowledge and services. The goal for these activities is to set the foundation for a new national community-based primary health care (CBPHC) family planning research team. The priorities identified will be used by the CART-GRAC team to develop a programmatic research and researcher training agenda that will improve equitable access to optimal family planning knowledge and services and thus realize: •  A reduction in unintended pregnancies •  Improved awareness of optimal fertility timing leading to… •  Improved health for Canadian women and their families. Our Goal is to undertake primary healthcare family planning research that will lead to improvements in equitable access to high quality family planning knowledge, services and methods, particularly among vulnerable women and families throughout Canada.2 Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram1.  Understanding Family Planning Gaps and OpportunitiesA.  Forming a Canadian Contraception Access  Research NetworkDr. Wendy Norman, a CART-GRAC Team Leader, and community-based primary healthcare clinician scientist, explained the rationale for the formation of a national family planning research team, collaboration and network. Challenges facing contraception and abortion primary health care services in Canada are national in scope. Current disparities in access to services disproportionately affect marginalized and vulnerable populations. While innovative research is occurring in some provinces and successful innovative family planning service models do exist, little evaluation, knowledge translation and sharing is occurring between jurisdictions. A coordinated, collaborative approach has the potential to innovate and improve access to knowledge and services and thus to reduce unintended pregnancies nationwide. CaRT-gRaC’s objectives are to:•  Build a capable, collaborative interdisciplinary, cross-sectorial national family planning research team, collaboration and network;•  Develop a plan for a national research and researcher training program that will produce innovative, high quality family planning primary healthcare research in Canada; CaRT-gRaC envisions:•  a core team of 10-12 interdisciplinary researchers and key knowledge users from both public health and health services (i.e. leading health systems decision makers), •  collaborating with a wide range of national interdisciplinary researchers, knowledge users and communications experts•  consulting with an advisory panel including representatives of vulnerable populations of women, of health service providers, and interested national stakeholders.Core-Team vision:This model will optimize dissemination of CART-GRAC research findings and implementation of evidence-based practices into better community-based primary health care for women and families of Canada. National CollaboratorsNational Network of Health Service ProvidersWomen and Families of CanadaCore Team:Researchers, Clinicians & Health System Decision MakersCart-GraC Collaborations and networkCart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram 3(See Core Team Ideal Components, right: blue fields are direct knowledge users and health policy leaders, red fields represent interdisciplinary researchers and health service professionals with the green field of trainees and Junior researchers.)The current opportunity to realize this vision is offered within a 2012 CIHR grant competition to improve access to community-based primary health care (CBPHC) for vulnerable populations. Many populations experience significant disparities in access to knowledge and services supporting family planning (e.g., those in rural/remote locations; of First Nations, Inuit or Metis heritage; of low socio-economic status; youth; new immigrants and populations with mental health and addictions challenges). The CIHR award funding the CART-GRAC planning activities detailed in this report was provided to support an application for this five-year CBPHC Team Grant. Additional intents of the CIHR grant are to promote researcher capacity building, to create the next generation of researchers across Canada; and to increase the utilization of research evidence amongst primary health care system decision makers. B.  Meeting Global Family Planning NeedsDr. Dorothy Shaw, Vice President, Medical Affairs for BC Women’s Hospital & Health Centre, immediate past president of the International Federation of Gynecology and Obstetrics (FIGO), and Canadian spokesperson for the Partnership for Maternal, Newborn and Child Health, talked about the global family planning environment and its parallels to the Canadian experience, especially amongst marginalized and vulnerable populations. Half the world’s population is under 25 years of age, most living in developing countries, yet their reproductive and health needs seem to have been forgotten. Of the 200 million pregnancies resulting every year, roughly 80 million are unwanted, resulting in 20 million induced abortions and close to 50,000 deaths from unsafe abortions. Evidence suggests high maternal, perinatal and neonatal morbidity and mortality rates are associated with inadequate and poor quality health services, legal barriers, lack of political will, underfunding, as well as poverty and lack of education, among other challenges. There are significant efforts underway to tackle global family planning challenges. The United Nation’s Millennium Development Goal 5 focuses on improving maternal health. The targets are by 2015 to:Women having two children will spend about 5 years trying to get pregnant or being pregnant, and more than thirty years trying to avoid pregnancy. Dr. Dorothy ShawCore team ideal ComponentsClinician Scientists & Interdisciplinary Junior Co-InvestigatorsHealth ServicesHealth Economics,Population Health,Admin Database Expertise,Software DesignQuébec  and the North Leaders: MSSS, INSPQSexual & Reproductive Education,Social Science  Expertise,Law, EthicsBC Leaders:Public Health,  Min of Health Women’s Services,BC Women’s  Hospital Community-based Primary Healthcare,Clinician  ResearchersOntario Leaders: Public Health,  Women’s Health  Services, ECHO4 Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram1.  Reduce maternal mortality ratios by three quarters.2.  Achieve universal access to reproductive health.There are many parallels in terms of our work on national family planning issues to the global setting, for example in some of our marginalized and vulnerable populations the age demographics nearly reflect that in the developing world, access issues in Canada among those in northern and rural communities, among Aboriginal and immigrant populations and with those with mental health and substance use challenges are significant, and the shortage of health human resources is as relevant here as it is in developing countries. Ideas like task-shifting and sharing are already leading to better contraception access for women in developing countries and have been shown to be safe and effective in isolated developed world and even some Canadian trials. A key take-home message from Dr. Shaw was that ultimately, investing in family planning makes good economic sense. Every dollar spent on family planning saves at least $4 dollars that would have been spent treating complications arising from unplanned pregnancies. march 2011-February 2012•  Interviews with Key Stakeholders:–  Decision Makers in Public  Health and Health  Services Planning september-December 2011•  National Stakeholder Survey–  Examining access and  quality issues •  Interviews with Key Stakeholders:–  National Organizations Representing vulnerable  groups and those  representing healthcare professionalsoctober 22-25, 2011•  Clinician and Social  Scientist Input–  The North American Forum  on Family Planning:  CART-GRAC held a first  national Canadian family planning research  network meeting •  Key Informants Research Priorities Planning Meeting–  National family planning stakeholder meetingCart GraC timelineA key take-home message from Dr. Shaw was that ultimately, investing in family planning makes good economic sense. Every dollar spent on family planning saves at least $4 dollars that would have been spent treating complications arising from unplanned pregnancies. age-standardized induced abortion rate by health region (lHin), 2007 (per 100 women aged 15-49) Project for an Ontario Women’s Health Evidence-Based Report (POWER) StudyCart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram 5C.  National Scan:  Examples of Canadian  Family Planning ResearchHighlights from recent innovative research from Ontario, Quebec and British Columbia set the context for exploring current gaps and opportunities for the development of a national contraception and abortion research agenda, and highlight opportunities to share current province-specific successful models between jurisdictions.ontarioThe Ontario POWER study, funded by ECHO1, utilized large administrative datasets to examine population-based trends in abortion trends, teen pregnancy and intrauterine device (IUD) insertion rates. Dr. Sheila Dunn, a CART-GRAC Team Leader, said having access to Ontario’s robust databases allowed researchers to link socio-economic status, education and geographic regions. This enabled conclusions to be drawn about health equity with findings persuasive enough to encourage changes in health policy and practice.POWER study highlights include:–  Women living in the poorest 1  ECHO is an agency of the Ontario Ministry of Health and Long-Term Care.neighbourhoods had abortion rates  two times higher than those living in more affluent neighbourhoods.–  Urban women had abortion rates twice that of their rural counterparts.–  Teens in the lowest income brackets have birth rates six times higher than upper income women.–  Improved IUD insertion rates were driven by gynecologists, not family physicians. Dr. Dunn noted a number of questions arising from the POWER study for further investigation, including:2012•  Operating Grants to  begin National Research–  Applications for research funding planned for  spring-summer-fall 2012 may 2012•  CIHR CBPHC Team Grant,  Letter of Intent due october 2012 •  CIHR CBPHC Team Grant Application due (if invited) abortion rates in Quebec, per age groups 1995-2008National Institute of Statistics of Quebec 20116 Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram1.  Are lower abortion rates in some areas due to socio-cultural influences, better contraception or decreased access to abortion?2.  What factors affect high pregnancy and abortion rates in poorer teens?3.  What physician characteristics are associated with providing IUD insertion in family practice?QuebecDr. Edith Guilbert, a Clinician Scientist and medical advisor in the L’Institut national de santé publique du Québec (INSPQ), summarized the evolution of Quebec’s 2007 collaborative agreement in hormonal contraception. This novel task-shifting model allows women to access prescription contraception through a nurse and a pharmacist rather than requiring a physician consultation.Working with the Colleges of physicians, nurses and pharmacists, a model was developed to allow nurses to prescribe hormonal contraception to women for a six-month period. Task-shifting enabled nurses to evaluate patients, counsel, and provide a particular form similar to a prescription women could take to their local pharmacy to get hormonal contraception (pill, patch, etc.). The agreement was supported by a web-based nursing training program offering nurses university credit for completion. Dr. Guilbert noted further research is necessary to understand the factors influencing nurses prescribing contraception and a larger study is being launched to examine this question.–  IUD use in Quebec is 10% compared to the rest of Canada at 2%, which is thought to be due to provincial policies to subsidize contraception cost.British ColumbiaIn 2000, British Columbia became the first jurisdiction in North America to allow pharmacists to prescribe emergency contraception (EC). Dr. Judith Soon presented findings from pharmacoepidemiologic research using population-based administrative data to track EC and contraception utilization rates. Highlights from the youth sexual health research team studies included:–  Prior to 2000, there were approximately 8,000 prescriptions annually from physicians for EC. That rate essentially doubled in one year with the task-sharing change in health policy allowing pharmacists to prescribe approximately 7,000 EC per year. –  Teen pregnancy rates are much higher and contraception utilization rates much lower in northern British Columbia and among those with lower socio-economic status indicators. –  EC use in northern British Columbia is lower compared to the Lower Mainland despite higher demonstrated need.pattern of emergency Contraception (eC), prescribing by year and type of prescriberSoon JA, Levine M, Osmond BL, Ensom MHH, Fielding DW. Effects of Making Emergency Contraception Available without a Physicians’s Prescription: A Population-based Study. CMAJ 2005;172(7): 878-833.Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram 7–  Approximately 81% of all abortion services in British Columbia are concentrated in the Lower Mainland.–  Ethnographic research in two northern British Columbia communities has suggested that among sexually active youth, five times more used male condoms only than birth control pills or no contraceptive method.  British Columbia’s Contraception and Abortion Research Team (CART) has developed a provincially-based network of health care decision makers, health service professionals, researchers, and health policy leaders undertaking health services research including community-based health demonstration projects. Similar to the CART-GRAC national initiative, the aim is to reduce unintended pregnancies and improve access to contraception in British Columbia. D. Stakeholder ScanThe team leads shared preliminary results from the CART-GRAC Canadian Contraception Access Survey (CCAS) and from consultations with collaborators, service providers, and advocates for vulnerable groups nationwide. (For final results, see appendix C.)Most notable was the dramatic difference in the results between French-speaking respondents who were almost exclusively Quebec-based, who largely indicated successful achievement of equitable access to family planning knowledge, services and methods throughout Quebec, and those from the rest of Canada indicating wide gaps and inequities relating to access. Approximately 89% of respondents from predominantly English speaking provinces felt the marginalized or vulnerable groups of women they served have disproportionally more difficulty in accessing contraceptive services compared to 44% among French-speaking respondents, almost exclusively Quebecois. The biggest barriers for English Canada were cost and knowledge while French-speaking respondents highlighted administrative and health system barriers, noting the dearth of primary care CostKnowledgePsycho-socialDistanceAdmin/health systems42%21%18%10%9%19%29%13%FinancièresConnaissances Psychosociale35%3%Géographie Systèmes administratifs ou  au système de santé Barriers to access Difficultés d’accessibilitéNational surveys in English were predominantly answered by health service providers from of provinces other than Quebec, While the French versions were answered almost exclusively by those from Quebec. (For full survey results see Appendix C.)8 Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGramphysicians in Quebec (1 in 3 Quebecers  has no access to a primary care physician).Major cost barriers were the initial cost for IUDs (59%) and transportation (54%) for English respondents. Surprisingly, French respondents also highlighted the cost of the method (31%) as a major barrier, noting an issue with the provincial drug insurance plan in the case of women under 25 years of age living at home and thus on their parents’ provincial drug insurance plan. This situation precludes confidentiality, as contraceptive prescriptions are noted on the plan of the parents.Psycho-social barriers resonated across both groups with “embarrassment/fear about obtaining” (English 70%; French 41%) and “negative attitudes toward certain contraceptives” (English 63%; French 41%) as the two main barriers to accessing contraception.For quality of contraceptive care, 57% of English respondents compared to 21% of French stated that marginalized and vulnerable groups of women (including those of young age) are disproportionally receiving lower quality of contraceptive care.For both English and French respondents, poor client-provider relationships and limited contraception choices (ie.,“It’s the pill or nothing.”) were the main barriers to high quality contraception care.Access to abortion was a critical issue with 66% of English respondents knowing women who disproportionally have more difficulty accessing abortion services compared to only 10% in Quebec. It was noted that in English Canada, most medical or surgical abortions services are concentrated in urban centres and hampered by a slow referral system. In Quebec, every health area has an abortion provider compared to the rest of Canada where groups with the highest needs (e.g., remote) have no local provision at all for abortion. DiscussionThe initial survey results fomented much discussion about the differences between the Quebec health services delivery model and family planning services in the rest of the country, and which successes could potentially be shared across jurisdictions. Excellent access to provincial health administrative data in Ontario was seen as a potential strength to improve understanding and targeting of programming, as was the seamless collaboration in British Columbia between health system leaders, researchers and family planning health services. Participants actively explored opportunities for further study, challenges and potential solutions.Top 3 Groups Receiving Lower Quality of Contraceptive CareenGlisH responDents FrenCH responDents   18%   Low socio-economic status     16%  Under 18 years of age   14%   Living in northern & remote areas     13%  Coping with mental illness   13%   First Nations/Aboriginals     22%   Low socio-economic status“There are youth in need of quality contraceptive care but youth are not always an identified vulnerable group category. We need to show how youth are not being served and don’t have an identified primary care physician.”Dr. Dorothy ShawCart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram 9Success Factors of Quebec modelDr. Edith Guilbert noted that “access trumps everything” in Quebec. While there is a lack of primary care physicians, overall Quebec has been successful in improving access to contraception and abortion services based on 3 key factors: 1.  Subsidised contraception provision (low cost or free for all methods)2.  Task-sharing agreement to allow access to prescription contraceptives through nurses and pharmacists3.  Direct pharmacy access to emergency contraception Role of EducationThe Quebec model utilizes nurses in schools to increase access to contraception among youth. Participants noted a large variation in the level of nurse involvement in schools across the rest of Canada, with sexual health education varying widely in terms of quantity, quality, timing with respect to student grade, and frequency. In terms of strategies for programmatic research, reaching youth through schools was thought to be out of scope of what could be accomplished through the national collaboration within the first  five-year plan.measuring Reproductive CareAn influential survey of the Centers for Disease Control in the United States (The National Survey of Family Growth- NSFG) has collected information about determinants of sexuality, pregnancy outcomes, and access to contraception and abortion services since 1973. The NSFG provides a rich resource of data to guide health policy decision makers and service providers. More than twelve other developed countries have similar surveys to guide family planning policy-making and service delivery. Canada has no mechanism to collect such information on population needs or to understand our unique factors underlying disparities in access. participants including decision-makers present highlighted the need to develop a Canadian national family growth survey to collect Canadian-context data on trends and disparities in determinants of births and pregnancy rates, as an essential foundation to inform policy and health services planning. Participants including decision-makers present highlighted the need to develop a Canadian national family growth survey to collect Canadian-context data on trends and disparities in determinants of births and pregnancy rates, as an essential foundation to inform policy and health services planning. 10 Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram2. Setting Priorities, Building SolutionsAfter a morning of information gathering, the Nominal Group technique interactive afternoon sessions gave participants an opportunity to share their expertise and perspectives, with an aim to:•  Prioritize key unmet needs/problems into potential research themes•  Develop five to six research themes based on potential systematic changes, innovative solutions and data/research requirements.Participants began with a 15-minute individual exercise to reflect on their key issues and what they felt were unmet needs to advance family planning health services delivery. Next stakeholders moved into groups of two to three to share their reflections and find commonalities. Discussion proliferated as the smaller groups joined together into four large groups to synthesize and prioritize key themes and issues. The day ended with an engaging forum where participants determined six theme areas for concentration by the CART-GRAC national collaboration.The work undertaken by stakeholders at the planning session marked an integral part of the process to assist CART-GRAC team leads to define a clear, coherent national research program and develop  a coordinated national research team.A. Summary ThemesSix clear themes emerged from the robust group and forum discussions with specific ideas on how they could be utilized to support the overarching goal of advancing Canadian women’s access to optimal family planning knowledge and services. While many issues cut across themes, there was general agreement that the final six highlighted the key areas for CART-GRAC concentration. 1.  Develop a Comprehensive Research and Evaluation Framework, methods and approachParticipants noted the need for Canadian-based data that is accessible and inclusive. Suggestions included the creation of effective surveillance mechanisms to track indicators such as access, barriers, cost, sexual health behaviours and knowledge users and the determinants of health contributing to trends and disparities. Critical to this will be the tracking of subgroups to gain a deeper understanding of the issues facing marginalized populations. Such data is also vital to informing the business case for family planning health services and health policy. Engaging a broad base of stakeholders from within the vulnerable populations any research might investigate was cited as vital to creating context-sensitive and community-relevant research projects. “We need to know who are the community stakeholders. Youth and marginalized groups need to be part of these discussions.”Research approaches need to be intersectional, recognizing that contraception and abortion issues are cross-cutting. This includes “We need to spread the learning. It’s about multiplying pockets  of brilliance. “Pat Campbell, CEO, ECHOCart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram 111.  Develop a comprehensive research and evaluation framework, methods and approach2.  Improve understanding of, and solutions to, barriers to access 3.  Improve provider cultural competencies through education 4.  Inform understanding of needs and behaviours of high need segments of  the population 5.  Develop an effective system design and delivery 6.  Understand the broad sociological contextAdvancing access to optimal  family planning knowledge  and servicesCART-GRAC Summary Themes– 1.1  Multiples stakeholder engagement approach– 1.2  Data and indicators to measure access, cost-effectiveness, behaviours– 1.3  Methods: surveillance, national population survey, build on novel models of care, i.e. “multiply pockets of brilliance” (learning) – 1.4  Consider/assess opportunities for intersectionality across marginalized statuses– 2.1  Focus on marginalized populations: low socio-economic status (SES), rural/remote, immigrants, First Nations, disabled, lesbian, gay, bisexual, transgender and questioning (LGBTQ) – 2.2  Access barriers: economic (cost to person and provider), psychological, roles (e.g., parents) – 2.3  Provider attitudes, norms and knowledge – 2.4  Continuity of utilization of contraceptives in women who experience marginalization – 2.5  Access to skilled professional in acceptable time frame in an acceptable location– 3.1  Understand discrimination, women centred care, disabilities, immigrants, LGBTQ, poverty, violence– 3.2  Develop training and education models including new technologies, telehealth, Apps, Serious Games, etc.  – 3.3  Strengthen networks and community of practice for providers – 4.1  Violence and coercion: trauma-informed contraceptive care, sexual power, accessibility – 4.2  Marginalized populations: immigrants, transgendered, disabled, teens, impoverished– 4.3  Public education: role of social media, role of school system, role of community and social service agencies– 4.4  Continuity of utilization of contraceptives for women who experience marginalization – barriers to initiation, barriers to continuity, user perceptions of quality– 4.5  Culturally competent education for service users and adult women, teens, and men– 4.6  Quality of information: unbiased, medically accurate, Canadian, accessible, inclusive– 5.1  Service delivery: scope of practice and task sharing/shifting, continuity, coordination, confidentiality– 5.2  System design: abortion public system, shared care model, standards, indicators, policies and policy enablers– 6.1  Migration experience of immigrants, colonization history of  First Nations– 6.2   Stigmas e.g., towards sexuality and abortion– 6.3  Design system to consider evidence based, context sensitive,  central vs local, define success and develop outcome indicatorsGoAl THEMES SPECIFIC IDEAS12 Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGramacross population groups and across issues such as violence, coercion, geography and other factors.Knowledge translation was highlighted as vital to any comprehensive research and evaluation framework. Efforts should focus on spreading new knowledge and best practices: both those already successful within a province or provinces, and new models arising from the research of our team. Cart-GraC will aim to systematically identify, share knowledge between jurisdictions, and uniformly evaluate models of care to facilitate national implementation of optimal community-based primary health care family planning knowledge, services and methods.2.  Improve understanding of, and Solutions to, Barriers to accessAccess was a critical priority for all participants with many barriers to obtaining quality, timely, contraception and abortion services noted including cost, geography, attitudes, knowledge and continuity of care. Some stakeholders called for free and/or affordable contraception, especially for highly effective methods such as IUDs and hormonal contraception options. Others stressed the need to look at the role of parent and provider attitudes and knowledge as facilitators or barriers to family planning services. “We need to consider – why do women start and then stop using contraceptives? Use this as a starting point to broadening our understanding of how to improve access.” Another common element was the need to ensure the equitable distribution of services to address access for rural, northern and Aboriginal communities, especially around abortion services which, outside of Quebec, are concentrated in southern urban settings. “Improving knowledge and uptake of forgettable contraception, such as IUDs where contraception is excellent independent of daily or episodic user input, can help address many of the common barriers to achieving continuous effective contraception.”3. Improve Provider Cultural Competencies through EducationThis theme focused on health care provider knowledge, training and attitudes and how they influence access to contraception and abortion services. Much discussion focused on the need to learn more about, and learn how to best address, provider attitudes and practices. Another suggestion to improve vulnerable and marginalized women’s experiences of family planning services was the provision of “cultural humility” training to health care providers to better respond to women’s needs. Broad cultural competency has the potential to support better care for women with different abilities, languages and ensure care is women-centered. New technologies offer diverse opportunities for provider education such as the use of online games and curricula to enhance provider access to training. The members of GRAND (a NSERC network of Centers of Excellence in graphics, animation and design including university computer science faculty across Canada) had several excellent suggestions for improved, modern knowledge translation for both health service providers and patients, using web-based platforms independent of location.Many participants suggested the CART-GRAC network should expand beyond the health sector to include social scientists and other “people who contribute” to our knowledge. Suggestions included training social science researchers from the fields of law, politics, economics and other social science fields to support a new generation Participants suggest one of our objectives would to see access to service for the person in need, by an available skilled professional, within an acceptable time frame, in an acceptable location.We need to improve evidence-based knowledge among health service providers, not only related to modern family planning methods, but also sensitivity and awareness of the cultural and social context among specific populations.Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram 13of family planning researchers. This could help strengthen the CART-GRAC network and communities of practice for providers. Cart-GraC meeting participants called for research to find methods to support improved access to high quality contraception and abortion services through better provider education.4.  Inform understanding of Needs and Behaviours of marginalized and vulnerable Segments of the PopulationThe population theme centered on relations between individuals, populations and sub-populations and the context from which people and groups seek family planning care.Violence and coercion was a focal issue for participants, noting women who’ve experienced relationship violence have different experiences of access to care. Clinicians need to be aware and sensitive to this history by providing “trauma-informed sexual care.” Underpinning this issue was a call to educate youth about egalitarian sexual relationships as a means of primary prevention. Participants further expanded on this theme by highlighting the need for culturally sensitive to recognize the historical and/or systemic barriers to contraception access many marginalized groups face, such as First Nations and Aboriginal peoples.  The role of public education, whether at the individual, sub-population or population level, was deemed vital to improving Canadian family planning outcomes. The role of social media, the school system, communities and social services agencies were just a few sectors mentioned by participants as viaducts for effective information and knowledge transfer. The quality of that information and education was noted as important to improving awareness of options and access to contraception and abortion services. “We need unbiased, not pharmaceutical funded, Canadian-based, accessible, inclusive education,” said one participant5.  Develop Effective System Design and DeliveryKey issues for effective nationwide family planning systems were the need for integrated shared models of care, effective policies, sustainable resources and accountability through robust surveillance and monitoring. task-sharing was a top priority for participants, pointing to shared care models, where integration and coordination between allied health providers supported by effective referral systems, can improve access to family planning services. Many noted successes in Quebec and in developing countries where the scope of services provided by nurses and midwives and other allied health professionals has expanded in several instances to allow provision of contraception and abortion services.Effective family planning systems are also built on having access to robust data and surveillance tools. “We need indicators to identify what the problems are, what we do, and how do we do it to improve the management of the system”, said a stakeholder. Indicators are required to improve the understanding of not just users knowledge and behaviours but to measure cost effectiveness and access.Participants talked about a need for common standards and indicators that communities have to meet supported by a continuing feedback loop of data for communities to maintain the process. Many noted that the foundation of any effective family planning system is the provision of adequate resources and infrastructure to sustain and improve services.What about the guys?  We need best practices in teaching and engaging men in contraception planning, in the surveillance of men’s involvement in contraception engagement.“We need to look beyond physicians for the provision of contraception and abortion services. Throughout the world, family planning services are provided safely by midwives, nurses, and pharmacists. Could we be looking at models like this?”Dr. Wendy Norman“Stigma is something we need to address directly and continually.”Dr. Wendy Norman14 Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram6. understand the Broad Sociological ContextThe theme of context centered on the need to take into account the current environment, from politics to culture to socio-economic factors, in which populations, sub-populations and family planning services exist.Stakeholders highlighted the importance of the context informing the system. This included incorporating sociological and socio-cultural aspects, to the need to reduce disparities among marginalized populations, to understanding how power dynamics and historical factors (e.g., colonization of First Nations peoples) impacts a sub-population group’s access to and experience of contraception and abortion care.Effective services need to exist in a framework that is evidence based and context sensitive for each community and population group. One stakeholder described this as taking critical elements of a program and working with a community to design appropriate services based on their individual resources, challenges and opportunities.From the stigma abortion providers face to the stigma around openly discussing sexuality as a healthy aspect of peoples lives, participants saw it as necessity to address stigma in its broadest sense and at all levels. “What about happiness as an outcome measure? You may have an unplanned pregnancy but you may in the long run be happy. My perception of what would be the final indicator is happiness in reproductive health.” B.  Approach to the Research ProgramAs the CART-GRAC team leads and core research team move forward with development of a proposal to CIHR to fund a national family planning research program, one of the challenges is determining whether the approach should be one of depth or breadth. CART-GRAC team leads asked participants for opinions garnering these suggestions:•	 	Go	for	Breadth – Focus on an integrated program of research, 2-4 key strains or issues rather than 1 question. •	 	Emphasize	the	Team	Approach	– Demonstrate the creation of a new network of collaborators utilizing this grant as seed funding that will launch multiple other projects nationwide.•	 	Highlight	Knowledge	Development	and translation – Focus on the educational, training and knowledge transfer elements within and beyond the network. C. Pathways to ProgressReflecting on the day’s work as the planning session came to a close, participants offered their thoughts and advice on the team work ahead and the building of a national collaboration in family planning. 1. Be Strategic“People who work in women’s health are passionate about what we do… it’s one of our strengths, and we need to draw on that intelligence. But we also need to think about how to interact with the bigger systems, like tri-council agencies, to ensure we get funding to do the work we want to do.”“We need indicators to identify what the problems are, what we do, and how do we do it to improve the management of the system”, said a stakeholder.The stigma towards sexuality and abortion was deemed a critical cross-cutting contextual issue.“We have achieved the most success where initiatives are context-based and context sensitive.”Pat Campbell, CEO, ECHOCart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram 15“We need to speak the language that best speaks to our peer reviewers. Innovation is important as is the notion of task-sharing but we must also have excellent science and good methodology to hold it all together.”2. make the Business Case“We need to make the business case.  We need to be better at articulating and differentiating the Canadian context compared to the international situation, especially among our marginalized groups.”“The dollar issue is important. In reproductive health, especially among vulnerable populations, the strategic point is that we are working to save dollars amongst a difficult to serve population. This needs to be central to the business case with a dollar figure attached.” 3. Engage Broad Stakeholder Base“Value the engagement of the community in the development process.”“Invite other groups across Canada into this discussion. Create a bigger, more robust network. Keep the momentum going.”“Recognize we are asking for public money and the edge we have is our network, and how in the end we’ll go public with our findings and make it available to other researchers.”4. Next StepsThe CART-GRAC core team is gathering information and ideas collected at the planning session as well as from other consultative initiatives to organize thematic priorities for a clear, achievable national research and researcher training program on access to high quality family planning. The October 25, 2011 national planning session was vital to identify priorities, suggest solutions and pinpoint knowledge needed to support resolutions. The critical input provided by stakeholders will inform the setting of a five-year research and researcher training program with integrated knowledge translation.This initiative heralds a bold new frontier for family planning in Canada as the first-ever national network of family planning stakeholders working in concert and sharing ideas for the benefit of Canadian women and families.Comments, ideas and suggestions can be directed to the CART-GRAC team at: CART-GRAC@exchange.ubc.ca Tel: 1.877.9CART90  (1.877.922.7890) www.CART-GRAC.ca Comments, ideas  and suggestions can  be directed to the CART -GRAC team at: CART-GRAC@exchange.ubc.caTel: 1.877.9CART90  (1.877.922.7890) www.CART-GRAC.ca16 Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGramAppendicesCart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram 17Appendix A: Core Research Team Planning Meeting AgendamorninG UnDerstanDinG Family planninG Gaps & opportUnities   8:00 – 8:30 REGisTRATion,	BREAKfAsT	BuffET 8:30 – 9:15 Welcome and overview Drs. Norman (BC), Dunn (ON)     and Guilbert (QC) 9:15 – 9:35 meeting Global Family planning needs Dr. Dorothy Shaw9:35 – 10:15  national scan: state of Canadian Family planning  Team Leads; Group research – examples from British Columbia, ontario  and Quebec of research related to access, service  delivery and population based outcomes;  Group discussion 10:15 – 10:30 nuTRiTion	AnD	nETwoRKinG	BREAK	 10:30 – 12:00  stakeholder scan – summary from consultations  Team Leads; Group with collaborators, service providers, advocates  for vulnerable groups, and the Canadian  Contraception access survey 12:00 – 13:00 lUnCH  aFternoon settinG priorities, BUilDinG solUtions  13:00 – 13:15 Welcome and review agenda for afternoon Janet Brown13:15 – 14:30 nominal Group process:    prioritize 5-6 research themes Group14:30 – 14:50 nuTRiTion	AnD	nETwoRKinG	BREAK 14:50 – 15:00 introduce	the	Knowledge	Cafe Group15:00 – 16:00 Knowledge	Café	(A) Group16:00 –16:30 Knowledge	Café	(B) Group16:30 –17:00 Check out; closing remarks Group; Team Leads18 Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGramAppendix B: CART-GRAC Conference ParticipantsOctober 25, 2011, Toronto, OntarioConFerenCe orGaniZersWendy v. norman, British Columbia and Team Lead, Clinician-Researcher, family physician,  University of British Columbiasheila Dunn, Ontario Lead, Clinician-Researcher, family physician, University of Torontoedith Guilbert, Quebec Lead Clinician-Researcher, family physician, Institut national de santé publique du QuébecJudith soon, British Columbia, Research Coordinator, Pharmacy liaison,  Contraception researcher University of British ColumbiaHEALTH	sERViCE	DECision-MAKERsPerry	Kendall, British Columbia and Team Knowledge User lead, Provincial Medical Officer of Health,  BC Ministry of Health   pat Campbell, Ontario Knowledge User, Lead, Executive Director, Echo, Echo: Improving Women’s  Health in OntarioJulie soucy, Quebec Knowledge User Lead,  Head of Surveillance in Health Promotion and Prevention  at the Direction of Public Health of the Ministry,  Ministère de la Santé et des Services Sociaux du Québecisabelle Cote, Quebec, Coordinator, Family Planning and Abortion Services, Ministère de la Santé et des Services Sociaux du QuébecJan Christilaw, British Columbia,  President, BC Women’s Hospital & Health Centre paul Hassellback, British Columbia,  Medical Health Officer, Vancouver Island Health Authorityrita shahin, Ontario, Associate Medical Officer of Health, Toronto Public HealthresearCHers anD HealtH serviCe proviDersamélie Blanchet-Garneau, Québec, Nurse clinician/researcher in immigrant health,  Université de Montréalstirling Bryan, British Columbia, Health economic researcher, University of British ColumbiaJocelyn Downie, Nova Scotia, Women’s reproductive health and intersection of law, ethics and health care (LLB/LLM), Dalhousie Universitylorraine Ferris, Ontario, Medico-legal-ethics-policy researcher related to women’s health services, University of Torontoangel Foster, Ontario Mixed-methods researcher into women’s reproductive health, University of OttawaJean-yves Frappier, Quebec, Pediatric clinician/researcher in adolescent sexual health and abuse, Université de MontréalJanusz	Kaczorowski, Quebec, Medical sociologist focusing on primary care and health services research, Université de MontréalBill	Kapralos, Ontario, Computer Science and Engineering researcher,  Serious Games Development, University of Ontario Institute of TechnologyInvitees by Category, Name, Province, Expertise, Affiliated OrganizationCart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram 19mona loutfy, Ontario, Clinician/researcher specializing in women,  HIV and reproductive health, University of Toronto (Women’s College)lisa mcCarthy, Ontario, Pharmacist clinician/researcher in primary care,  Women’s College Hospitalpatricia mcniven, Ontario, Midwifery clinician/researcher, McMaster Universityrahim moineddin, Ontario, Bio-statistician researcher, University of Torontoregina-marie renner, British Columbia, Obstetrics/Gynecology clinician/researcher in family planning, University of British Columbiaelizabeth saewyc, British Columbia, Vulnerable Youth Behaviour researcher, University  of British ColumbiaJean shoveller, British Columbia, Social contexts of youth sexual health inequities researcher University of British Columbiaeleni stroulia, Alberta, Computer Science researcher, Virtual Reality Education tools (PhD), University of AlbertaleaDersHip in orGaniZations representinG Women’s HealtHmarie-noelle Caron, Quebec, Public Health Advisor, Commission de la santé et  des services sociaux des premières nations du Québec  et LabradorGeri Bailey, Ontario, Manager, Health Policy and Programs, Pauktuutit  Inuit Women of Canada ainsley Jenicek, Quebec,  Communications specialist, Fédération du Québec pour  le planning des naissanceslola mc namara, Quebec, Nurse in charge, Le Comite québécois de vigilance  sur l’avortementDorothy shaw, British Columbia, Past President, FIGO, Vice President, Medical Affairs, BC Women’s Hospital & Health CentreReGReTs fRom:  Paul Hasselback, Perry Kendall, Julie Soucy, Rahim Moineddin, Amanda Black, Geri Bailey, Jocelyn Downie and Mona Loutfy (Logan Kennedy attending on her behalf).20 Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGramAppendix C: Stakeholder Scan1. National Stakeholder and Expert Interviewsactionable Themes from CaRT-gRaC Stakeholder ConsultationsThese themes emerged from analysis of the interviews between CART-GRAC leaders and executive directors or other leading professionals among key 14 national organizations relevant to family planning health services. Theme 1:  Priorities in developing educational initiatives to facilitate use of highly effective methods of contraception among vulnerable populationsWhat are the priorities in developing educational initiatives for the public, health care providers and decision-makers to increase knowledge and favorable opinions about use of highly effective methods of contraception for vulnerable populations?–  Enhance and publicize availability of accurate online and social media contraception and sexual health resources for the public–  Develop standardized interdisciplinary Canada-wide undergraduate and continuing professional education training in family planning, including surgical and medical abortion, that is case-based, culturally sensitive and includes new contraceptive methods–  Demonstrate the benefit of IUD insertion training programs for health care professionals (e.g., physicians, nurse practitioners, nurses, midwives) practicing in underserviced areas –  Provide Community Health Representatives among Aboriginal communities with advanced training and resources related to family planning–  Emphasize the importance of preventing Sexually Transmitted Infections (STIs) through the use of contraceptives and barrier methods to protect future fertility–  Encourage the provision of ongoing sex education early and throughout high school–  Proactively plan for the release of mifepristone in Canada and facilitate training of allied health professionals to provide this agent in underserved areas Theme 2:  Recommendations to facilitate task-sharing of family planning services for vulnerable populations What health system changes are necessary to facilitate the training, certification and employment of allied healthcare professionals able to directly provide family planning services in distant, rural or urban areas where these services are lacking?–  Propose expanded interdisciplinary use of telehealth facilities for family planning service consultations to facilitate access in underserved regions–  Utilize telephone consultations among allied healthcare professionals (nurses, pharmacists, midwives) to obtain authorization for contraception–  Explore the interest of Colleges of allied health professionals and their members across Canada to facilitate the direct confidential provision of contraception –  Express support for the provision of family planning information and contraceptives in secondary schools, colleges and universitiesTheme 3:  Requirements needed to sustain integrated accessible family planning servicesWhat is required to develop and sustain a fully integrated accessible system of family planning services available for vulnerable populations?What challenges does your organization face when advocating for improved family planning services for vulnerable populations?–  Advocate for expanded access to a full range of family planning contraceptive options for Aboriginal women, with a minimum of Non-Insured Health Benefits paperwork–  Replicate successful programs such as the BC Pregnancy Options Service in other jurisdictions to enable patient referral to rural providers for timely access to abortions–  Recognize and support the role of family physicians in providing care to vulnerable populationsCart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram 21–  Support the desirability of multiple access points to the health care system to meet a range of patient-centred needs for family planning services Theme 4:  expectations for equitable and affordable access to family planning methodsWhat changes in health care policy and financing are necessary to facilitate low-cost long acting reversible methods of contraception?What changes in health care policy and financing are necessary to facilitate access to all contraceptive methods to First Nations and immigrant populations?–  Leverage a national voice for family planning services to improve access to equitable and affordable family planning services for Aboriginals across Canada–  Enhance funding for family planning health service programs for vulnerable and marginalized women to enable provision of free contraceptives, especially the long acting reversible contraceptive methods –  Investigate the development of a cohesive and consistent reimbursement mechanism for family planning methods among third party payers and government plans–  Provide decision-makers with the outcomes of cost-effectiveness family planning research–  Share “best practices” of successful family planning programs to enable tailored and targeted expansion into other jurisdictions; similarly, share findings of unsuccessful programs so that scarce resources are not unnecessarily expended–  Publicize the Non-Insured Health Benefits program to allied health professionals to minimize the unnecessary demand for payment of services that are reimbursable–  Recognize the importance of coverage for transportation/accommodation/meals and a support person for rural and remote women needing to travel extended distances to urban settings to access abortion services –  Discuss with Health Canada and the Public Health Agency of Canada the desirability of providing their high quality sexual health kits to communities north of 60° as well as those south of 60° N. Theme 5:  enhancing consistency of high quality family planning services across CanadaWhat changes are necessary to improve quality of care in family planning all across the country?–  Understand and support the need for culturally sensitive, tailored and targeted family planning initiatives in remote and northern communities, through the conduct of needs assessments utilizing traditional processes –  Expand the ability of allied health care professionals to appropriately counsel patients, and where necessary triage and refer patients for health care services such as STIs and contraception–  Encourage interdisciplinary training early in undergraduate health care professional training programs to facilitate collaboration and team work–  Publicize standardized protocols with simple checklists for providing family planning services to primary care providers and allied health professionals–  Promote the expectation that basic family planning knowledge and skills such as IUD insertion should be incorporated into the education of medical residents and other appropriate allied health professionals (e.g., midwives, nurse practitioners)22 Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram2. Clinician and Social Scientist Collaborators National CaRT-gRaC Network foundation meeting  within the North american Forum on Family Planning, October 23, 2011 This workshop is an example of several CART-GRAC has held at significant national and international meetings of family planning clinicians, clinician researchers and social scientists. The session was fully subscribed by enthusiastic English and French speaking attendees (extra chairs were brought in for those standing at the back early in the session) and more than 30 people enlisted to join the CART-GRAC network.“CaRT-gRaC Canada: Forming a Canadian Contraception & abortion Research Team and Network”This bilingual session welcomed interested contraception and abortion focused Social Scientists and Clinician Researchers from North America, and throughout the world, with a particular focus on those currently or planning to undertake research in Canada. Brief presentations by CART-GRAC leaders were followed by open dialogue with workshop participants exploring and developing appropriate themes, collaborations and strategies to inform the CART-GRAC research program agenda.We propose to compare and contrast provincial experience aiming to bring knowledge of the most effective policies and programs to all provinces.objectives for the session included:1.  Understand the current state of contraception and abortion research in Canada;2.  Discuss possible methods to support research between and within provinces where a national research collaboration will be able to enhance effectiveness and knowledge translation;3.  Form an understanding of potential upcoming research grant opportunities, that may be suitable to support inter-provincial primary healthcare research collaboration;4.  Be able to describe and understand issue specific information on addressing common national contraception and abortion challenges;5.  Understand a Community-Based Primary Healthcare Research Team model, engaging government and appropriate knowledge users and health system decision makers in development of effective contraception and abortion research questions, to better facilitate knowledge translation and program continuation into a post research phase.The session was enthusiastically attended by an international group of Francophone and Anglophone social scientist and clinician researchers, and research trainees, actively engaging in the exploration of potential collaborations and potential project ideas for CART-GRAC’s network. Session leaders:Dr. Wendy V. Norman, Clinical Professor, UBC,  Vancouver, BC. (lead)Dr. Edith Guilbert, Professor, Laval University,  Quebec City, QuebecDr. Sheila Dunn, Associate Professor,  University of Toronto, Toronto, OntarioDr. Judith Soon, Assistant Professor,  University of British Columbia, Vancouver, BCCart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram 233.  National Stakeholder Surveys: Canadian Contraceptive Access Survey (CCAS) Canadian	  Contracep-on	  	  Access	  Survey:	  	  Service	  Providers	  Survey	  period:	  	  October	  6,	  2011	  –	  January	  20,	  2012	  CART-­‐GRAC	  -­‐	  Contracep-on	  Access	  Research	  Team	  Groupe	  de	  reserche	  sur	  laccessibilite	  a	  la	  contracep-on	  January	  29,	  2012	  (n=191) *  %    %     % (n=150)    % 26% 15%   % (n=150 )   34%  72%   % %  5%  5%  %   8%  Respondents’ Demographics(n=150)Laccès	  à	  la	  Contracep0on	  	  au	  Canada:	  	  Enquête	  auprès	  des	  fournisseurs	  de	  soins	  Période	  d'enquête:	  	  Octobre	  6,	  2011	  –	  Janvier	  20,	  2012	  CART-­‐GRAC	  -­‐	  Contracep0on	  Access	  Research	  Team	  Groupe	  de	  reserche	  sur	  laccessibilite	  a	  la	  contracep0on	  Février	  25,	  2012	   (n=64)*(n=56)(n=56)As the answers for most Access and Quality of Service questions varied significantly between Quebec Francophone respondents, and those of all other Canadian regions (responding in English), we will show side by side the French vs English responses to selected questions.*plus d’un choix24 Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram(n=150)Access	  to	  Contracep-ve	  Services	  83%	  of	  respondents	  stated	  that	  the	  women	  they	  served	  have	  dis-­‐propor6onally	  more	  difficulty	  in	  accessing	  contracep6ve	  services	  	  	  Barriers	  to	  Access	  Groups	  of	  Affected	  Women	  Access	  to	  Contracep-ve	  Services	  	  Cost/Financial	  Barriers	  Contracep*ves	  for	  women	  should	  be	  fully	  covered	  under	  our	  basic	  provincial	  health	  care	  plan.	  The	  working	  poor	  woman	  balks	  at	  the	  price	  of	  contracep*on.	  DAccès	  aux	  services	  contracep0fs	  	  DIFFICULTÉS	  FINANCIÈRES	  Si	  les	  parents	  ont	  une	  assurance	  privée,	  les	  frais	  de	  contracep:on	  des	  ados	  apparaissent	  sur	  le	  rapport	  mensuel	  envoyé	  aux	  parents.	  Si	  les	  ados	  ne	  veulent	  pas	  que	  leurs	  parents	  soient	  au	  courant,	  elles	  doivent	  payer	  et	  nont	  pas	  dargent.	  	  (n=348)* (n=122) (n=95)* (n=31)* Could select up to 3 choices (n=150) (n=56)*Pouvaient sélectionner jusqu'à 3 choixGroupes	  de	  femmes	  vulnérables	  rencontrées	  	  .par	  les	  fournisseurs	  de	  soins…	  .  %	  Faible	  statut	  socio-­‐économique	   79%	  Moins	  de	  19	  ans	   91%	  Ayant	  des	  problèmes	  de	  santé	  mentale	  	   55%	  Toxicomanes	   	  45%	  	  Première	  Na0ons/Autochtones	  	   21%	  Vivant	  dans	  des	  logements	  subven0onnés	   23%	  Non	  couvertes	  par	  une	  assurance	  santé	  	   45%	  Nouvelles	  immigrantes	  et	  réfugiées	   30%	  Handicapées	   18%	  Travailleuses	  du	  sexe	  	   14%	  Sans	  abri	   9%	  Habitant	  les	  régions	  nordiques	  ou	  éloignées	   7%	  (n=56)Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram 25Access	  to	  Contracep-ve	  Services	  	  Geography/Distance	  Barriers	  Confiden*ality	  concerns	  in	  small	  town.;	  Interpreters	  only	  available	  in	  some	  clinics.	  	  The	  few	  stores	  get	  closed	  on	  weekends.	  Access	  to	  Contracep-ve	  Services	  	  Administra-ve/Health	  Systems	  Barriers	  Many	  clinics	  are	  not	  accep*ng	  new	  pa*ents	  [so]	  women	  cannot	  book	  pap	  smears	  or	  contracep*ve	  prescrip*ons	  	  Access	  to	  Contracep-ve	  Services	  	  Knowledge	  Barriers	  Women	  believe	  the	  myths.Fears	  based	  on	  false	  informa*on.	  	  Other	  countries	  have	  special	  family	  planning	  clinics,	  which	  are	  free,	  run	  by	  female	  staff,	  and	  provide	  free	  contracep*ves,	  PAPs,	  pregnancy	  tes*ng.	  Accès	  aux	  services	  contracep0fs	  	  DIFFICULTÉS	  GÉOGRAPHIQUES	  Accès	  aux	  services	  contracep0fs	  DIFFICULTÉS	  LIÉS	  AUX	  SYSTÈMES	  ADMINISTRATIFS	  La	  majorité	  des	  femmes	  sont	  incapables	  de	  trouver	  un	  médecin.	  	  Lini:a:on	  de	  la	  contracep:on	  par	  linfirmière	  scolaire	  a	  beaucoup	  facilité	  laccessibilité.	  Accès	  aux	  services	  contracep0fs	  	  MANQUE	  DE	  CONNAISSANCES	  Manque	  de	  connaissances	  pour	  les	  ados.	  (n=150)(n=56)(n=150)(n=56)(n=150) (n=56)26 Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGramAccess	  to	  Contracep-ve	  Services	  	  Psycho-­‐social	  Barriers	  Partner	  not	  allowing	  access	  to	  contracep*on.	  Women	  feel	  that	  physicians/clinics	  have	  nega*ve	  aJtudes/discriminate	  against	  them.	  Prac**oners	  arent	  prac*cing	  in	  a	  culturally	  competent	  way…clients	  feel	  the	  s*gma.	  Accès	  aux	  services	  contracep0fs	  	  DIFFICULTÉS	  DE	  NATURE	  PSYCHO-­‐SOCIALE	  7% 20% 13% 39% 39% Percep0on	  néga0ves	  des	  services	  et	   des	  professionnels	  de	  planning	   … Pression	  de	  l'entourage	  pour	  qu'elles	   aient	  des	  enfants Préoccupa0on	  quant	  à	  la	   confiden0alité	  des	  services Aktude	  néga0ve	  à	  l'égard	  de	   certaines	  méthodes	  contracep0ves Peur	  ou	  in0midée	  de	  consulter	  pour	   la	  contracep0on (n=150) (n=56)(n=150) (n=56)(n=148) (n=56)(n=41)*(n=230)*Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram 27Barriers	  to	  High	  Quality	  Contracep-ve	  Care	  Family	  physician	  unwilling	  to	  prescribe.;	  Going	  to	  a	  walk-­‐in	  clinic	  for	  sexual	  health	  services	  is	  far	  from	  ideal.;	  It	  is	  extremely	  difficult	  for	  low	  income	  women	  to	  obtain;	  partly	  due	  to	  cost,	  and	  partly	  due	  to	  lack	  of	  privacy	  in	  our	  medical	  system.	  Access	  to	  Abor-on	  Services	  64%	  of	  respondents	  are	  aware	  of	  certain	  groups	  of	  women	  who	  have	  dispropor-onally	  more	  difficulty	  accessing	  abor-on	  services	  Barriers	  to	  Accessing	  	  Abor-on	  Services	  Difficultés	  d’accessibilité	  à	  	  des	  soins	  de	  haute	  qualité	  2%2%7%18%7%16%Manque	  de	  confidentialitéManque	  de	  compétences 	  techniques	  des	  professionnelsÉventail	  restreint	  de	  servicesCapacité	  limitée	  de	  suivi	  et	  de	  continuité	  des	  soinsÉventail	  restreint	  de	  méthodes	  contraceptivesPiètre	  lien	  de	  confiance	  entre	  la	  cliente	  et	  leprofessionnelPas	  de	  relance	  chez	  les	  adolescentes	  absentes	  aux	  rendez-­‐vous	  de	  suivi.	  Plusieurs	  arrêtent	  leur	  contracep:on	  car	  elles	  ont	  omis	  leur	  rendez-­‐vous	  et	  leur	  prescrip:on	  est	  échue	  –	  risque	  de	  grossesse	  +++.	  En	  région	  éloignée,	  les	  femmes	  doivent	  se	  présenter	  à	  lurgence	  lorsquelles	  nont	  pas	  de	  médecin	  traitant.	  Laccueil	  quon	  leur	  réserve	  est	  peu	  agréable.	  Difficultés	  d’accès	  aux	  services	  d’IVG	  22%0%11%44%22%Manque	  de	  connaissances	  sur	  les	  cliniques	  IVG,	  etc.Difficultés	  financières:	  coût	  de	  la	  procédure,	  transportDifficulté	  de	  nature	  psycho-­‐socialeDifficultés	  liés	  aux	  systèmes	  administratifsDifficulté	  de	  nature	  géographique(n=150)(n=56)(n=150)(n=56)Groups of affected women (n=244) * * Could select up to 3 choices(n=26)*(n=94)(n=9)* Pourrait faire jusqu’à trois choix28 Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGramAccessing	  Abor-on	  Services	  Geography/Distance	  barriers	  One	  or	  two	  nurses	  in	  a	  community	  –	  if	  they	  are	  an*-­‐choice,	  the	  referral	  is	  blocked.	  People	  dont	  want	  to	  go	  to	  clinics	  where	  there	  is	  picke*ng	  close	  by.	  Lack	  of	  available	  clinics	  and	  hours.;	  Post	  TA	  checkup	  also	  requires	  travel.	  Accessing	  Abor-on	  Services	  Administra-ve/Health	  Services	  barriers	  Lack	  of	  awareness	  of	  how	  to	  self-­‐ref	  to	  abor*on	  services	  and	  to	  navigate	  system.When	  women	  do	  not	  speak	  English	  well	  they	  cant	  advocate	  for	  themselves.	  	  Threats	  to	  local	  physicians	  if	  services	  offered.	  Accessing	  Abor-on	  Services	  Knowledge	  barriers	  Unaware	  cost	  is	  covered	  by	  Medicare..;	  Medical	  abor*on	  is	  generally	  not	  available.A	  poli*cal	  group	  in	  geographic	  region	  ac*vely	  provides	  mis-­‐informa*on	  on	  abor*on:	  	  Accès	  aux	  services	  d’IVG	  DIFFICULTÉS	  D’ORDRE	  GÉOGRAPHIQUE	  14%13%14%11%Ralentissement	  du	  système	  de	  référence	  en	  raison	  de	  la	  distanceService	  d'IVG	  médicale	  trop	  éloignéeServices	  du	  2e	  trimestre	  chirurgicale	  trop	  éloignésServices	  du	  1er	  trimestre	  chirurgicale	  trop	  éloignésAccès	  aux	  services	  d’IVG	  DIFFICULTÉS	  LIÉS	  AUX	  SYSTÈMES	  ADMINISTRATIFS	  7%9%9%14%Le	  conseil	  d'administration	  ou	  la	  direction	  de	  l'hôpital	  restreint	  la	  pratique	  des	  IVG	  de	  l'établissementListe	  d'attente	  ou	  long	  délai	  d’attente	  pour	  obtenir	  un	  rendez-­‐vousHeures	  d’ouverture	  restreintes	  des	  cliniques	  spécialisées	  en	  IVGDifficulté	  d'obtenir	  la	  référence	  pour	  une	  IVG	  Accès	  aux	  services	  d’IVG	  	  	  MANQUE	  DE	  CONNAISSANCES	  4%9%14%16%Préoccupé	  outre	  mesure	  de	  la	  sécurité	  d'une	  IVG	  et	  des	  risques	  pour	  leur	  fertilité	  ultérieureIgnorent	  où	  et	  comment	  obtenir	  des	  services	  d’IVGNe	  savent	  pas	  qu'une	  IVG	  médicale	  peut	  se	  pratiquer	  avant	  la	  septième	   semaine	  de	  grossesse.Ne	  savent	  pas	  que	  l'IVG	  est	  une	  solution	  ni	  à	  quel	  moment	  de	  la	  grossesse	  elle	  se	  pratique(n=150) (n=56)(n=150)(n=56)(n=150) (n=56)Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram 29Accessing	  Abor-on	  Services	  Psycho-­‐social	  barriers	  Worried	  	  its	  illegal.;	  Might	  want	  to	  consider	  whether	  or	  not	  women	  who	  are	  HIV+	  are	  being	  pressured	  to	  abort	  when	  they	  want	  to	  be	  pregnant.;	  Strong	  group	  of	  Chris*an	  physicians	  who	  pressure	  other	  physicians	  not	  to	  offer	  abor*on	  services.	  Accessing	  Abor-on	  Services	  Cost/Financial	  Barriers	  The	  provinces	  by	  not	  including	  abor*on	  in	  reciprocal	  payment	  agreements	  are	  contravening	  the	  Canada	  Health	  Act,	  as	  well	  as	  compromising	  the	  cons*tu*onal	  rights	  of	  women.	  Further	  Training/CE	  Sought	  by	  	  Service	  Providers	  Accès	  aux	  services	  d’IVG	  DIFFICULTÉS	  D’ORDRE	  PSYCHO-­‐SOCIAL	  2%4%9%16%16%Les	  femmes	  sont	  préoccupées	  de	  la	  compétence	  des	  professionnelsLes	  femmes	  se	  sentent	  stigmatisées	  ou	  jugées	  par	  les	  professionnelsManque	  de	  confidentialitéPression	  de	  l'entourage	  pour	  ne	  pas	  avoir	  recours	  à	  l'IVGCroyances	  religieuses	  ou	  culturelles	  obligeant	  les	  femmes	  au	  secretAccès	  aux	  services	  d’IVG	  	  	  DIFFICULTÉS	  FINANCIÈRES	  	  4%7%11%16%Remboursement	  incomplet	  des	  frais	  d'avortementCoût	  de	  la	  procédure,	  coût	  non	  remboursé	  par	  le	  régime	  d’assurance	  santéPerte	  de	  revenu	  causée	  par	  le	  congé	  du	  travail	  ou	  le	  recours	  à	  un	  service	  de	  garde	  d’enfantsFrais	  de	  transport	  Forma0on	  ou	  perfec0onnement	  demandé	  par	  les	  fournisseurs	  de	  soins	  4%14%9%11%22%12%Mises	  à	  jour	  sur	  les	  autres	  indications	  du	  LNG-­‐IUS,	  des	  contraceptifs	  oraux,	  etc.Techiques	  d'IVG	  chirurgicale	  et	  médicaleMise	  à	  jour	  sur	  la	  gestion	  des	  effets	   secondaires	  des	  méthodes	  contraceptivesMise	  à	  jour	  sur	  les	  stratégies	  de	  counselingTechnique	  d'installation	  du	  diaphragme,	  cape	  cervicale,	  stérilet,	  bloc	  cervicalMise	  à	  jour	  sur	  les	  critères	  d'admissibilité	  des	  stérilets	  et	  autres	  méthodes	  contraceptives(n=150) (n=56)(n=150) (n=56)(n=150) (n=56)30 Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGramComments….	  —  Client-­‐centred	  and	  holis:c	  models	  of	  care	  have	  been	  the	  most	  successful	  in	  reaching	  and	  connec:ng	  with	  women	  from	  marginalized	  communi:es.	  —  Bring	  medical	  services	  to	  community	  centres	  where	  marginalized	  women	  may	  access.	  —  I	  would	  like	  to	  see	  female-­‐staffed	  family	  planning	  clinics	  for	  women	  to	  aDend;	  free	  of	  charge,	  with	  all	  contracep:ves	  being	  covered	  under	  our	  basic	  provincial	  medical	  service	  plans.	  —  You	  need	  to	  look	  at	  HIV	  primary	  care	  physicians	  who	  are	  quite	  successful	  in	  helping	  women	  who	  know	  their	  HIV	  status,	  plan	  and	  :me	  their	  pregnancies…they	  are	  a	  good	  role	  model.	  Comments….	  —  More	  on-­‐going	  an:-­‐oppression	  training	  for	  service	  providers	  to	  strengthen	  competencies	  in	  working	  with	  diverse,	  under-­‐served	  and	  vulnerable	  communi:es.	  —  Every	  contracep:ve	  method	  should	  be	  free	  for	  any	  woman	  in	  Canada	  who	  would	  choose	  to	  use	  one.	  —  Recently,	  we	  have	  had	  both	  research	  and	  educa:on	  programs	  offering	  free	  copper	  and	  Mirena	  IUDs	  to	  women	  in	  BC	  seen	  at	  the	  :me	  of	  an	  abor:on.	  	  This	  appears	  to	  have	  helped	  many	  women	  avoid	  a	  future	  abor:on;	  our	  wait	  list	  for	  abor:ons	  have	  diminished	  significantly.	  Comments….	  — We	  know	  from	  Ontario	  research	  that	  condom	  machines	  in	  high	  schools	  significantly	  reduce	  pregnancy	  and	  thus	  abor:on.	  But	  many	  places	  remain	  remote	  and	  far	  from	  places	  to	  buy	  condoms	  etc.	  — A	  travelling	  clinic	  to	  remote	  areas	  for	  contracep:ve	  services.	  — Ask	  physicians	  who	  provide	  contracep:on	  to	  pa:ents	  to	  men:on	  that	  If	  the	  method	  fails,	  we	  can	  talk	  about	  your	  op:ons…	  to	  indicate	  he/she	  would	  provide	  informa:on	  about	  abor:on	  care	  if	  required.	  Commentaires….	  •  Suivi	  de	  près,	  relance	  téléphonique	  pour	  suivi	  et	  lors	  dabsences	  aux	  rendez-­‐vous.	  Disponibilités	  de	  rendez-­‐vous	  rapide	  pour	  ado	  qui	  a	  besoin	  de	  contracep6on	  et	  est	  à	  risque	  +++.	  Échan6llons	  de	  diverses	  méthodes	  remis	  aux	  ados	  lorsquelles	  nont	  pas	  dargent.	  •  	  Accessibilité	  à	  tous.	  •  Accès	  à	  la	  clinique	  jeunesse.	  Disponibilité	  de	  plusieurs	  collègues	  dans	  le	  suivi	  en	  ma6ère	  de	  planning.	  Commentaires….	  •  Clinique	  de	  planning	  offrant	  la	  gamme	  complète	  des	  moyens	  de	  contracep6on,	  y	  compris	  lIVG	  jusquà	  15	  semaines	  de	  grossesse	  dans	  le	  système	  public.	  •  Assurance	  médicament	  couvre	  les	  stérilets.	  •  Laccès	  via	  le	  CLSC	  de	  la	  région,	  les	  plages	  horaires	  privilégiées	  en	  échographie	  au	  CH	  de	  la	  région	  et	  des	  médecins	  consciencieux	  et	  humain	  qui	  respectent,	  tout	  en	  éduquant	  les	  femmes	  qui	  traversent	  ce	  parcours	  de	  vie.	  Commentaires….	  •  Distribu6on	  gratuite	  de	  la	  COU	  dans	  les	  écoles	  et	  CLSC,	  adop6on	  de	  lOC	  de	  CH.	  •  Mesures	  financières	  daide	  au	  transport	  et	  accompagnement	  ainsi	  quenseignement	  auprès	  des	  professionnels.	  •  Disponibilité	  de	  linfirmière	  en	  planning	  et	  la	  facilité	  pour	  entrer	  en	  contact	  avec	  elle.	  Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGram 31Appendix D: Collaboration with GRAND(An NSERC funded Network of Centers of Excellence in Graphics, Animation and New Media)Report to the gRaND PEakS Committeere:  the planning meeting of the Contraception  access research team, october 25, 2011From: eleni stroulia, pni (HltHsim, meoW),  Bill	Kapralos,	Cni	(DiGLT)On Tuesday, October 25, 2011, Drs. Kapralos (DIGLT) and Stroulia (HLTHSIM, MEOW) participated in The Planning Meeting of the Contraception Access Research Team, organized by Drs. Wendy Norman (UBC), Edith Guilbert (INSPQ), and Sheila Dunn (Women’s College Hospital, Ontario). The purpose of the meeting was to bring together clinicians, care providers, social workers, decisions makers and technologists, interested in putting together a grant application to CIHR in April 2012, for a long-term program to improve the health of marginalized and vulnerable women and their families, through improved access to high-quality family-planning knowledge and services.As GRAND researchers, our objective was (a) to identify opportunities for collaboration between the GRAND community and the network that Drs. Norman, Guilbert and Dunn putting together, and, to the extent possible, (b) to formulate ideas for specific research projects to be pursued in the context of their grant proposal or other proposals.At this point, we see the following project ideas:1.  Developing virtual-patient simulations to train care providers from diverse disciplines, including family medicine, nursing and pharmacy, in advising patients on their reproductive health issues. This activity would rely on our HLTHSIM/DIGLT platforms to help with the training of these professionals in the current context of “task sharing” (a term reflecting the re-negotiation of the scope of services potentially delivered by each discipline).2.  Developing serious games to educate the general public about reproductive-health issues and available services, with a special focus to youth who are particularly engaged in gaming. Such a project would again rely on our HLTHSIM/DIGLT platforms and tools.3.  Developing instruments and platforms to collect and analyze data about the current state of the public’s reproductive-health knowledge, practices and use of services. The instruments would be “open” and could be adopted by interested agencies to collect data across Canada, across demographics, and across socio-economic status. This data could further be linked with other open-data (building on current open-data and linked-data initiatives) to investigate questions around the relative needs across Canada and potential impact of specific initiatives. This project could potentially involve GRAND researchers interested in social studies (NAVEL), information dissemination (NEWS) and information search strategies (NGAIA).4.  Developing a new type of collaboratory platform (akin to the GRAND Forum) to support the formation and sustainability of this community.32 Cart–GraC: DevelopinG a national Family planninG primary HealtHCare researCH proGramWomen's Health Research Institute BC Women’s Hospital and Health CentreE202 - 4500 Oak StreetVancouver, BC  V6H 1N3 cart-grac@exchange.ubc.ca www.cart-grac.ca

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