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Papers by Stephen Ritchie

Introduction: The Remote First Aid Self-Efficacy Scale was originally developed as a 30-item self... more Introduction: The Remote First Aid Self-Efficacy Scale was originally developed as a 30-item self-report instrument designed as an evaluation tool for training providers and a reflection tool for course participants. Remote first aid training courses and programs are designed for remote communities, worksites, and other wilderness contexts involving activities such as recreation, education, and therapy. Self-efficacy refers to the strength of the beliefs a person has in their capacity to organize and take the necessary actions towards any given attainment. The purpose of our study was to measure the reliability and validity of the 15-Item Remote First Aid Self-Efficacy Scale (RFA SES) in French and English populations. Methods: Alumni from SIRIUSMEDx wilderness first aid courses were invited via email to complete either a French or English online questionnaire at two different time periods (T1 & T2). Data collection involved using online questionnaires containing demographic questions, the 15-Item RFA SES, and the 10-Item Generalized Self-Efficacy Scale (GSES). Data analysis involved assessing the scale for internal consistency, test re-test reliability, and concurrent validity. Results: There were 58 French and 47 English alumni respondents from SIRIUSMEDx courses for a total of 105 respondents. Internal consistency was high amongst the French group (alpha = .95) and the English group (alpha = .92). Test re-test reliability was high amongst the French group, (r = 0.78, p < .01), and the English group (r = .92, p < .01). The correlations between the RFS SES and GSES were positive and moderate in the French group (r = 0.53, p < .01), as well as in the English group (r = 0.32, p = .03). Conclusions: Results from this study suggest that both the French and English 15-Item RFA SES are reliable and valid. This shorter 15-item version is now available for use, along with the original validated 30-Item version of the RFA SES. Future research should focus on validation of the scale in other contexts and populations, using the scale as a participant reflection tool, and using it for evaluation of training programs and courses.

International Journal of Environmental Research and Public Health

Heart rate variability (HRV) is a psychophysiological variable that is often used in applied anal... more Heart rate variability (HRV) is a psychophysiological variable that is often used in applied analysis techniques to indicate health status because it provides a window into the intrinsic regulation of the autonomic nervous system. However, HRV data analysis methods are varied and complex, which has led to different approaches to data collection, analysis, and interpretation of results. Our scoping review aimed to explore the diverse use of HRV methods in studies designed to assess health outcomes in outdoor free-living contexts. Four database indexes were searched, which resulted in the identification of 17,505 candidate studies. There were 34 studies and eight systematic reviews that met the inclusion criteria. Just over half of the papers referenced the 1996 task force paper that outlined the standards of measurement and physiological interpretation of HRV data, with even fewer adhering to recommended HRV recording and analysis procedures. Most authors reported an increase in para...

International Journal of Behavioral Nutrition and Physical Activity

Background A recent dialogue in the field of play, learn, and teach outdoors (referred to as “PLa... more Background A recent dialogue in the field of play, learn, and teach outdoors (referred to as “PLaTO” hereafter) demonstrated the need for developing harmonized and consensus-based terminology, taxonomy, and ontology for PLaTO. This is important as the field evolves and diversifies in its approaches, contents, and contexts over time and in different countries, cultures, and settings. Within this paper, we report the systematic and iterative processes undertaken to achieve this objective, which has built on the creation of the global PLaTO-Network (PLaTO-Net). Methods This project comprised of four major methodological phases. First, a systematic scoping review was conducted to identify common terms and definitions used pertaining to PLaTO. Second, based on the results of the scoping review, a draft set of key terms, taxonomy, and ontology were developed, and shared with PLaTO members, who provided feedback via four rounds of consultation. Third, PLaTO terminology, taxonomy, and ontol...

The Qualitative Report, 2021

In this paper, I (S. L. Deibert) share my story of discovering the relationship between reflexivi... more In this paper, I (S. L. Deibert) share my story of discovering the relationship between reflexivity, autoethnography, and yoga through a meaningful experience. Yoga has been an important influence on my physical and mental well-being for over a decade, but I did not consider its implications in my academic life until I was asked to write a reflexive assignment for a course. The task was exploring who I am in connection to my master’s thesis project; the challenge was finding a starting point for my reflexive journey of self-discovery. Frustrated by the latter, I turned to yoga for refuge; instead of escaping the assignment, I found that my quest for self-exploration was intertwined with my yoga practice. The purpose of this paper is to delve further into my experience with yoga as a medium for developing reflexivity. Using autoethnography, I share my journey of developing critical thinking through a narrative related to my yoga class experience. Linking my research to my yoga practi...

Medicine & Science in Sports & Exercise, 2018

Background: Oxidative stress results in lipid, protein, and DNA oxidation, resulting in telomere ... more Background: Oxidative stress results in lipid, protein, and DNA oxidation, resulting in telomere erosion, chromosomal damage, and accelerated cellular aging. Training promotes healthy metabolic and oxidative profiles whereas the effects of multi-day, prolonged, and continuous exercise are unknown. This study investigated the effects of multi-day prolonged exercise on metabolic and oxidative stress as well as telomere integrity in healthy adults. Methods: Fifteen participants performed a 14-day, 260-km, wilderness canoeing expedition (12 males) (EXP) (24 ± 7 years, 72 ± 6 kg, 178 ± 8.0 cm, 18.4 ± 8.4% BF, 47.5 ± 9.3 mlO 2 kg −1 min −1), requiring 6-9 h of low-to moderate-intensity exercise daily. Ten controls participated locally (seven males) (CON) (31 ± 11 years, 72 ± 15 kg, 174 ± 10 cm, 22.8 ± 10.0% BF, 47.1 ± 9.0 mlO 2 kg −1 min −1). Blood plasma, serum, and mononuclear cells were sampled before and after the expedition to assess hormonal, metabolic, and oxidative changes. Results: Serum cholesterol, high-and low-density lipoprotein, testosterone, insulin, sodium, potassium, urea, and chloride concentrations were not different between groups, whereas triglycerides, glucose, and creatinine levels were lower following the expedition (p < 0.001). Malondialdehyde and relative telomere length (TL) were unaffected (EXP: 4.2 ± 1.3 vs. CON: 4.1 ± 0.7 µM; p > 0.05; EXP: 1.00 ± 0.48 vs. CON: 0.89 ± 0.28 TS ratio; p = 0.77, respectively); however, superoxidase dismutase activity was greater in the expedition group (3.1 ± 0.4 vs. 0.8 ± 0.5 U ml −1 ; p < 0.001). Conclusion: These results indicate a modest improvement in metabolic and oxidative profiles with increased superoxidase dismutase levels, suggesting an antioxidative

Journal of Experiential Education, 2008

The general purpose of the present study was to examine the relationship between status congruenc... more The general purpose of the present study was to examine the relationship between status congruency and group cohesion in an outdoor expedition setting. Specifically, three aspects of status congruency were assessed in relation to group cohesion in four adventure canoe groups. These groups were participating in two week expeditions in the northern areas of the Canadian provinces of Ontario and Quebec. The participants were 32 upper year undergraduate students enrolled in a central Canadian university (M age = 22.41 + 2.43 years). Results indicated that (a) individuals who ranked themselves higher in the group's status hierarchy compared to where their peers ranked them had decreased attractions to social aspects of the group; (b) perceptions of group cohesion were greater when individuals occupying formal leadership positions were higher in the group's status ranking (i.e., greater congruency between formal and informal status hierarchies); and (c) individuals who were members of groups that had some level of consensus regarding status rankings perceived their groups to be more cohesive than those who were members of a group that had no consensus.

Bulletin of the World Health Organization, 2021

Objective To assess the individual and community health effects of task shifting for emergency ca... more Objective To assess the individual and community health effects of task shifting for emergency care in low-resource settings and underserved populations worldwide. Methods We systematically searched 13 databases and additional grey literature for studies published between 1984 and 2019. Eligible studies involved emergency care training for laypeople in underserved or low-resource populations, and any quantitative assessment of effects on the health of individuals or communities. We conducted duplicate assessments of study eligibility, data abstraction and quality. We synthesized findings in narrative and tabular format. Findings Of 19 308 papers retrieved, 34 studies met the inclusion criteria from low-and middle-income countries (21 studies) and underserved populations in high-income countries (13 studies). Targeted emergency conditions included trauma, burns, cardiac arrest, opioid poisoning, malaria, paediatric communicable diseases and malnutrition. Trainees included the general public, non-health-care professionals, volunteers and close contacts of at-risk populations, all trained through in-class, peer and multimodal education and public awareness campaigns. Important clinical and policy outcomes included improvements in community capacity to manage emergencies (14 studies), patient outcomes (13 studies) and community health (seven studies). While substantial effects were observed for programmes to address paediatric malaria, trauma and opioid poisoning, most studies reported modest effect sizes and two reported null results. Most studies were of weak (24 studies) or moderate quality (nine studies). Conclusion First aid education and task shifting to laypeople for emergency care may reduce patient morbidity and mortality and build community capacity to manage health emergencies for a variety of emergency conditions in underserved and low-resource settings.

Rural and Remote Health, 2021

Human Resources for Health, 2021

Background Task shifting and sharing (TS/S) involves the redistribution of health tasks within wo... more Background Task shifting and sharing (TS/S) involves the redistribution of health tasks within workforces and communities. Conceptual frameworks lay out the key factors, constructs, and variables involved in a given phenomenon, as well as the relationships between those factors. Though TS/S is a leading strategy to address health worker shortages and improve access to services worldwide, a conceptual framework for this approach is lacking. Methods We used an online Delphi process to engage an international panel of scholars with experience in knowledge synthesis concerning TS/S and develop a conceptual framework for TS/S. We invited 55 prospective panelists to participate in a series of questionnaires exploring the purpose of TS/S and the characteristics of contexts amenable to TS/S programmes. Panelist responses were analysed and integrated through an iterative process to achieve consensus on the elements included in the conceptual framework. Results The panel achieved consensus co...

Rural and Remote Health, 2014

Context: Community-based first aid training is the collaborative development of locally relevant ... more Context: Community-based first aid training is the collaborative development of locally relevant emergency response training. The Sachigo Lake Wilderness Emergency Response Education Initiative was developed, delivered, and evaluated through two intensive 5-day first aid courses. Sachigo Lake First Nation is a remote Aboriginal community of 450 people in northern Ontario, Canada, with no local paramedical services. These courses were developed in collaboration with the community, with a goal of building community capacity to respond to medical emergencies. Issue: Most first aid training programs rely on standardized curriculum developed for urban and rural contexts with established emergency response systems. Delivering effective community-based first aid training in a remote Aboriginal community required specific adaptations to conventional first aid educational content and pedagogy. Lessons learned: Three key lessons emerged during this program that used collaborative principles to adapt conventional first aid concepts and curriculum: (1) standardized approaches may not be relevant nor appropriate; (2) relationships between course

Rural and Remote Health, 2014

Introduction: Aboriginal people in Canada (First Nations, Inuit and Métis) have a lower health st... more Introduction: Aboriginal people in Canada (First Nations, Inuit and Métis) have a lower health status compared to the Canadian population. There is a particular concern about the mental health and wellbeing of First Nations adolescents living on reserves. Interventions following principles of outdoor education and adventure therapy appear to be an appropriate fit for this population. These approaches have proven effective in non-Aboriginal populations, yet there is very little evidence on the efficacy of these types of program for Aboriginal adolescents. The primary purpose of this study was to evaluate the impact of an outdoor adventure leadership experience (OALE) on the resilience and wellbeing of First Nations adolescents from one reserve community. The secondary purposes were to explore whether this impact was sustainable, and whether there were any intervening factors that may have influenced the impact. Methods: The collaborative research team used a mixed-method design to evaluate the 10-day OALE for adolescents from Wikwemikong Unceded Indian Reserve in northern Ontario, Canada. The main outcome assessed was resilience, measured by selfreport, using the 14-Item Resilience Scale (RS-14). Several other exploratory measures assessed other aspects of health and wellbeing. The questionnaire package was administered at three different time periods: (T1) one day before the OALE; (T2) one month after the OALE; and (T3) one year after the OALE. The Mental Component Score (MCS) of the SF-12v2 was used to confirm any changes in resilience. Open-ended questions were appended to the questionnaire at the 1-year point to identify any intervening © SD Ritchie, M-J Wabano, K Russell, L Enosse, NL Young, 2014. A licence to publish this material has been given to James Cook University, http://www.rrh.org.au 2 factors that may have impacted any changes in resilience and wellbeing. The primary analysis compared mean RS-14 scores at T1 with those at T2. Responses to the open-ended questions were analyzed using content analysis. Results: Over two summers (2009 and 2010), 73 youth 12-18 years of age from Wikwemikong participated in a standardized 10day OALE program. This represented 15% of the on-reserve population of adolescents in this age range. Survey responses from 59 (80.8%) participants were available for analysis at T1, compared to 47 (64.4%) at T2 and 33 (45.2%) at T3. The mean RS-14 score was 73.65 at baseline, and this improved 3.40 points (p=0.011) between T1 and T2. However, the resilience scores at T3 (1 year post-OALE) had a mean of 74.19, indicating a return back to pre-OALE levels. The mean MCS score at T1 was 48.23 and it improved over the subsequent two time periods. Several intervening factors reported at T3 may have influenced the decrease in resilience scores from T2 to T3. These included changes in family living situation, death in the family, and other life stressors that occurred over the course of the year. Conclusions: Outcome scores from this study provide a unique glimpse into the self-reported health and wellbeing for adolescents within one First Nations community in Canada. The OALE program was beneficial in promoting resilience for adolescents in Wikwemikong over the short-term. Future studies are necessary to assess whether the OALE (or similar outdoor type interventions) are effective within other communities.

CJEM, 2018

Introduction: The World Health Organization recommends emergency care training for laypeople in l... more Introduction: The World Health Organization recommends emergency care training for laypeople in low-resource settings, but the effects of these programs on patient outcomes and community health have not been systematically reviewed. Our objective was to identify the individual and community health effects of educating laypeople to deliver emergency care in low-resource settings. Methods: We conducted a systematic review to address this question: in low-resource populations (P), does emergency care education for laypeople (I) confer any measurable effect on patient morbidity and mortality, or community capacity and resilience for emergency health conditions (O), in comparison with no training or other education(C)? We searched 12 electronic databases and grey literature for quantitative studies. We conducted duplicate and independent title and abstract screening, methodological and outcomes extraction, and study quality assessment using the Effective Public Health Practice Tool. We d...

CMAJ Open, 2020

A lmost all residents of Ontario, Canada live within 30 minutes of an emergency department. 1 How... more A lmost all residents of Ontario, Canada live within 30 minutes of an emergency department. 1 However, for about 25 000 Ontarians living in remote commun ities, accessing a doctor in an emergency department requires flying in a plane or helicopter. 1 Patients in these northern com munities access medical care through a local nursing station, with intermittent incommunity physician coverage. Patients with highacuity conditions are transported from remote com munities to hospital by Ornge, the provincial medical air ambulance service provider. 2,3 Even under ideal conditions, these transfers take several hours. Air transports from these communities can face delays due to weather, visibility, mechan ical issues and personnel issues. More than half of the associ ated remote airports do not have key visual aids that pilots use to land aircraft during periods of reduced visibility, which makes medical transports dependent on weather conditions. 4 First Nations populations living in remote communities are known to face challenging social determinants of health: isolated geography, insufficient housing, unemployment, and the cultural impact of colonialism and residential schools. 5 Access to potable water is an issue in many communities, with 188 boil water advisories in First Nations in the Sioux Look out area between 2007 and 2016. 6 These populations face trauma at rates 2.5-8 times greater than the Canadian aver age. 7-10 People living in these communities face elevated rates of chronic disease, which manifest as critical health emergen cies including mental health, infectious disease, diabetic and cardiovascular emergencies. 11-14 The characteristics of patients requiring air medical trans port in this region have not been well described, with only a handful of published papers describing medical emergencies in these remote communities over the last 35 years. 2,6,7,15,16 We aimed to describe who is transported from 26 remote Nish nawbe Aski Nation communities in northern Ontario to access hospitalbased emergency medical care and to describe the primary clinical reason for their transport as stated in the

Canadian Journal of Public Health, 2013

OBJECTIVES: The purpose of this study was to identify concepts of health and well-being important... more OBJECTIVES: The purpose of this study was to identify concepts of health and well-being important to Aboriginal children and youth. These concepts were necessary for the development of a culturally appropriate measure of health. METHODS: We completed 4 community consultation sessions, 4 advisory committee meetings, and 6 full-day focus groups within the Wikwemikong Unceded Indian Reserve. The focus groups engaged Aboriginal children and youth via relevant cultural teachings, a photography exercise combined with a community bicycling tour, and detailed discussions of health and well-being using photovoice. The process was guided by a conceptual model: the Medicine Wheel. The participants placed their photos on a wall mural and identified their most important concepts. These concepts were synthesized through expert consensus into items and reviewed by the broader community. RESULTS: The participants ranged in age from 8.2 to 17.7 years (mean age=12.3). Through innovative methods, children and youth identified 206 concepts representing the 4 quadrants of the Medicine Wheel: emotional, spiritual, physical and mental. These concepts were refocused, in collaboration with the community, to create a new 60-item measure of health and well-being that was primarily positive in focus. CONCLUSION: This study demonstrates the success of implementing a unique process of photovoice in combination with bicycling and informed by an Aboriginal framework. The results confirm the distinct conceptualization of health and well-being in this population and underscore the necessity for a culturally appropriate measure. This study also produced a first draft of the Aboriginal Children's Health and Well-being Measure (ACHWM).

International journal of environmental research and public health, Jan 4, 2018

(1) Background: Remote communities in Canada lack an equitable emergency medical response capacit... more (1) Background: Remote communities in Canada lack an equitable emergency medical response capacity compared to other communities. Community-based emergency care (CBEC) training for laypeople is a model that has the potential to enhance the medical emergency response capacity in isolated and resource-limited contexts. The purpose of this study was to understand the characteristics of medical emergencies and to conceptualize and present a framework for what a medical emergency is for one remote Indigenous community in northwestern Ontario, in order to inform the development of CBEC training. (2) Methods: This study adhered to the principles of community-based participatory research and realist evaluation; it was an integrated component of the formative evaluation of the second Sachigo Lake Wilderness Emergency Response Education Initiative (SLWEREI) training course in 2012. Twelve members of Sachigo Lake First Nation participated in the training course, along with local nursing staff, police officers, community Elders, and course instructors (n = 24 total), who participated in interviews, focus groups, and a collaborative discussion of local health issues in the development of the SLWEREI. (3) Results: The qualitative results are organized into sections that describe the types of local health emergencies and the informal response system of community members in addressing these emergencies. Prominent themes of health adversity that emerged were an inability to manage chronic conditions and fears of exacerbations, the lack of capacity for addressing mental illness, and the high prevalence of injury for community members. (4) Discussion: A three-point framework of what constitutes local perceptions of an emergency emerged from the findings in this study: (1) a sense of isolation; (2) a condition with a potentially adverse outcome; and (3) a need for help.

Journal of Physical Activity and Health, 2010

Background:There has been a recent push in the sport psychology literature for sport participants... more Background:There has been a recent push in the sport psychology literature for sport participants to be approached based on their cultural backgrounds. However, there are few examples where a cultural approach is considered, such as a culturally reflexive version of participatory action research (PAR). In the current study, the role of family is considered in relation to the sport engagement of Canadian Aboriginal youth.Methods:Mainstream researchers teamed with coresearchers from the Wikwemikong Unceded Indian Reserve for 5 years. Community meetings and talking circles were employed as culturally sensitive data collection techniques to uncover how to encourage youth participation in Wikwemikong’s sport programs. The overarching methodology for the project is PAR.Results:Themes and subthemes were determined by community consensus with terms indigenous (ie, culturally relevant) among the local Aboriginal culture. Family was considered important for youth involvement in Aboriginal com...

BMJ open, May 18, 2016

The Disease Control Priorities Project recommends emergency care training for laypersons in low-r... more The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. This systematic review addresses the following question: in underserviced populations and low-resource settings (P), does first aid or emergency care training or education for laypeople (I) confer any individual or community health benefit for emergency health conditions (O), in comparison with no training or other forms of education (C)? We restrict this review to studies reporting quantitatively measurable outcomes, and search 12 electronic bibliographic databases and grey literature sources. A team of expert content and methodology reviewers will conduct title and abstract screening and full-text review, using a custom-bu...

Pathways the Ontario Journal of Outdoor Education, 2011

Connecting through outdoor adventure is a process that may or may not seem obvious. For us, the w... more Connecting through outdoor adventure is a process that may or may not seem obvious. For us, the word "connecting" resonates with a powerful and extensive implied meaning that we feel compelled to share. A recent collaborative research project between leaders from Wikwemikong Unceded Indian Reserve and researchers from Laurentian University helped to uncover, or perhaps rediscover, that meaning through a series of outdoor adventure leadership experiences (OALE) designed for youth from this northern Ontario First Nations reserve (Ritchie et al., 2010). Wikwemikong is a large reserve located at the eastern end of Manitoulin Island in Georgian Bay. The OALE involved a 10day wilderness canoe excursion homeward through the traditional territory of the Wikwemikong community. The route followed the historic French River and then proceeded along the north shore of Georgian Bay towards Killarney and then across the channel to Manitoulin Island. Over two summers nearly 16 percent of the on-reserve population of youth who were between 12 and 18 years of age had completed the program.

Journal of Sport and Social Issues, 2010

Within the motivation literature, it has been indicated that athletes respond more effectively to... more Within the motivation literature, it has been indicated that athletes respond more effectively to sport’s contextual challenges through effective adaptation skills. Fiske identified five core motives as facilitators of the adaptation process across cultures: belonging, understanding, controlling, self-enhancement, and trusting. Through a cultural sport psychology approach, the adaptation challenges and strategies of Canadian Aboriginal adolescent athletes from one community (Wikwemikong) are described as they traveled off reserve to compete in mainstream sporting events. Concurrently, Fiske’s core motives are considered in relation to youth sport participants from the aforementioned Aboriginal community. Culture sensitive research methods among the Wikwemikong, including community meetings, talking circles (TCs), indigenous coding, and coauthoring, were employed in this article. Data are reflected in three themes: (a) challenges pursuing sport outside of the Aboriginal community in ...

Introduction: The Remote First Aid Self-Efficacy Scale was originally developed as a 30-item self... more Introduction: The Remote First Aid Self-Efficacy Scale was originally developed as a 30-item self-report instrument designed as an evaluation tool for training providers and a reflection tool for course participants. Remote first aid training courses and programs are designed for remote communities, worksites, and other wilderness contexts involving activities such as recreation, education, and therapy. Self-efficacy refers to the strength of the beliefs a person has in their capacity to organize and take the necessary actions towards any given attainment. The purpose of our study was to measure the reliability and validity of the 15-Item Remote First Aid Self-Efficacy Scale (RFA SES) in French and English populations. Methods: Alumni from SIRIUSMEDx wilderness first aid courses were invited via email to complete either a French or English online questionnaire at two different time periods (T1 & T2). Data collection involved using online questionnaires containing demographic questions, the 15-Item RFA SES, and the 10-Item Generalized Self-Efficacy Scale (GSES). Data analysis involved assessing the scale for internal consistency, test re-test reliability, and concurrent validity. Results: There were 58 French and 47 English alumni respondents from SIRIUSMEDx courses for a total of 105 respondents. Internal consistency was high amongst the French group (alpha = .95) and the English group (alpha = .92). Test re-test reliability was high amongst the French group, (r = 0.78, p < .01), and the English group (r = .92, p < .01). The correlations between the RFS SES and GSES were positive and moderate in the French group (r = 0.53, p < .01), as well as in the English group (r = 0.32, p = .03). Conclusions: Results from this study suggest that both the French and English 15-Item RFA SES are reliable and valid. This shorter 15-item version is now available for use, along with the original validated 30-Item version of the RFA SES. Future research should focus on validation of the scale in other contexts and populations, using the scale as a participant reflection tool, and using it for evaluation of training programs and courses.

International Journal of Environmental Research and Public Health

Heart rate variability (HRV) is a psychophysiological variable that is often used in applied anal... more Heart rate variability (HRV) is a psychophysiological variable that is often used in applied analysis techniques to indicate health status because it provides a window into the intrinsic regulation of the autonomic nervous system. However, HRV data analysis methods are varied and complex, which has led to different approaches to data collection, analysis, and interpretation of results. Our scoping review aimed to explore the diverse use of HRV methods in studies designed to assess health outcomes in outdoor free-living contexts. Four database indexes were searched, which resulted in the identification of 17,505 candidate studies. There were 34 studies and eight systematic reviews that met the inclusion criteria. Just over half of the papers referenced the 1996 task force paper that outlined the standards of measurement and physiological interpretation of HRV data, with even fewer adhering to recommended HRV recording and analysis procedures. Most authors reported an increase in para...

International Journal of Behavioral Nutrition and Physical Activity

Background A recent dialogue in the field of play, learn, and teach outdoors (referred to as “PLa... more Background A recent dialogue in the field of play, learn, and teach outdoors (referred to as “PLaTO” hereafter) demonstrated the need for developing harmonized and consensus-based terminology, taxonomy, and ontology for PLaTO. This is important as the field evolves and diversifies in its approaches, contents, and contexts over time and in different countries, cultures, and settings. Within this paper, we report the systematic and iterative processes undertaken to achieve this objective, which has built on the creation of the global PLaTO-Network (PLaTO-Net). Methods This project comprised of four major methodological phases. First, a systematic scoping review was conducted to identify common terms and definitions used pertaining to PLaTO. Second, based on the results of the scoping review, a draft set of key terms, taxonomy, and ontology were developed, and shared with PLaTO members, who provided feedback via four rounds of consultation. Third, PLaTO terminology, taxonomy, and ontol...

The Qualitative Report, 2021

In this paper, I (S. L. Deibert) share my story of discovering the relationship between reflexivi... more In this paper, I (S. L. Deibert) share my story of discovering the relationship between reflexivity, autoethnography, and yoga through a meaningful experience. Yoga has been an important influence on my physical and mental well-being for over a decade, but I did not consider its implications in my academic life until I was asked to write a reflexive assignment for a course. The task was exploring who I am in connection to my master’s thesis project; the challenge was finding a starting point for my reflexive journey of self-discovery. Frustrated by the latter, I turned to yoga for refuge; instead of escaping the assignment, I found that my quest for self-exploration was intertwined with my yoga practice. The purpose of this paper is to delve further into my experience with yoga as a medium for developing reflexivity. Using autoethnography, I share my journey of developing critical thinking through a narrative related to my yoga class experience. Linking my research to my yoga practi...

Medicine & Science in Sports & Exercise, 2018

Background: Oxidative stress results in lipid, protein, and DNA oxidation, resulting in telomere ... more Background: Oxidative stress results in lipid, protein, and DNA oxidation, resulting in telomere erosion, chromosomal damage, and accelerated cellular aging. Training promotes healthy metabolic and oxidative profiles whereas the effects of multi-day, prolonged, and continuous exercise are unknown. This study investigated the effects of multi-day prolonged exercise on metabolic and oxidative stress as well as telomere integrity in healthy adults. Methods: Fifteen participants performed a 14-day, 260-km, wilderness canoeing expedition (12 males) (EXP) (24 ± 7 years, 72 ± 6 kg, 178 ± 8.0 cm, 18.4 ± 8.4% BF, 47.5 ± 9.3 mlO 2 kg −1 min −1), requiring 6-9 h of low-to moderate-intensity exercise daily. Ten controls participated locally (seven males) (CON) (31 ± 11 years, 72 ± 15 kg, 174 ± 10 cm, 22.8 ± 10.0% BF, 47.1 ± 9.0 mlO 2 kg −1 min −1). Blood plasma, serum, and mononuclear cells were sampled before and after the expedition to assess hormonal, metabolic, and oxidative changes. Results: Serum cholesterol, high-and low-density lipoprotein, testosterone, insulin, sodium, potassium, urea, and chloride concentrations were not different between groups, whereas triglycerides, glucose, and creatinine levels were lower following the expedition (p < 0.001). Malondialdehyde and relative telomere length (TL) were unaffected (EXP: 4.2 ± 1.3 vs. CON: 4.1 ± 0.7 µM; p > 0.05; EXP: 1.00 ± 0.48 vs. CON: 0.89 ± 0.28 TS ratio; p = 0.77, respectively); however, superoxidase dismutase activity was greater in the expedition group (3.1 ± 0.4 vs. 0.8 ± 0.5 U ml −1 ; p < 0.001). Conclusion: These results indicate a modest improvement in metabolic and oxidative profiles with increased superoxidase dismutase levels, suggesting an antioxidative

Journal of Experiential Education, 2008

The general purpose of the present study was to examine the relationship between status congruenc... more The general purpose of the present study was to examine the relationship between status congruency and group cohesion in an outdoor expedition setting. Specifically, three aspects of status congruency were assessed in relation to group cohesion in four adventure canoe groups. These groups were participating in two week expeditions in the northern areas of the Canadian provinces of Ontario and Quebec. The participants were 32 upper year undergraduate students enrolled in a central Canadian university (M age = 22.41 + 2.43 years). Results indicated that (a) individuals who ranked themselves higher in the group's status hierarchy compared to where their peers ranked them had decreased attractions to social aspects of the group; (b) perceptions of group cohesion were greater when individuals occupying formal leadership positions were higher in the group's status ranking (i.e., greater congruency between formal and informal status hierarchies); and (c) individuals who were members of groups that had some level of consensus regarding status rankings perceived their groups to be more cohesive than those who were members of a group that had no consensus.

Bulletin of the World Health Organization, 2021

Objective To assess the individual and community health effects of task shifting for emergency ca... more Objective To assess the individual and community health effects of task shifting for emergency care in low-resource settings and underserved populations worldwide. Methods We systematically searched 13 databases and additional grey literature for studies published between 1984 and 2019. Eligible studies involved emergency care training for laypeople in underserved or low-resource populations, and any quantitative assessment of effects on the health of individuals or communities. We conducted duplicate assessments of study eligibility, data abstraction and quality. We synthesized findings in narrative and tabular format. Findings Of 19 308 papers retrieved, 34 studies met the inclusion criteria from low-and middle-income countries (21 studies) and underserved populations in high-income countries (13 studies). Targeted emergency conditions included trauma, burns, cardiac arrest, opioid poisoning, malaria, paediatric communicable diseases and malnutrition. Trainees included the general public, non-health-care professionals, volunteers and close contacts of at-risk populations, all trained through in-class, peer and multimodal education and public awareness campaigns. Important clinical and policy outcomes included improvements in community capacity to manage emergencies (14 studies), patient outcomes (13 studies) and community health (seven studies). While substantial effects were observed for programmes to address paediatric malaria, trauma and opioid poisoning, most studies reported modest effect sizes and two reported null results. Most studies were of weak (24 studies) or moderate quality (nine studies). Conclusion First aid education and task shifting to laypeople for emergency care may reduce patient morbidity and mortality and build community capacity to manage health emergencies for a variety of emergency conditions in underserved and low-resource settings.

Rural and Remote Health, 2021

Human Resources for Health, 2021

Background Task shifting and sharing (TS/S) involves the redistribution of health tasks within wo... more Background Task shifting and sharing (TS/S) involves the redistribution of health tasks within workforces and communities. Conceptual frameworks lay out the key factors, constructs, and variables involved in a given phenomenon, as well as the relationships between those factors. Though TS/S is a leading strategy to address health worker shortages and improve access to services worldwide, a conceptual framework for this approach is lacking. Methods We used an online Delphi process to engage an international panel of scholars with experience in knowledge synthesis concerning TS/S and develop a conceptual framework for TS/S. We invited 55 prospective panelists to participate in a series of questionnaires exploring the purpose of TS/S and the characteristics of contexts amenable to TS/S programmes. Panelist responses were analysed and integrated through an iterative process to achieve consensus on the elements included in the conceptual framework. Results The panel achieved consensus co...

Rural and Remote Health, 2014

Context: Community-based first aid training is the collaborative development of locally relevant ... more Context: Community-based first aid training is the collaborative development of locally relevant emergency response training. The Sachigo Lake Wilderness Emergency Response Education Initiative was developed, delivered, and evaluated through two intensive 5-day first aid courses. Sachigo Lake First Nation is a remote Aboriginal community of 450 people in northern Ontario, Canada, with no local paramedical services. These courses were developed in collaboration with the community, with a goal of building community capacity to respond to medical emergencies. Issue: Most first aid training programs rely on standardized curriculum developed for urban and rural contexts with established emergency response systems. Delivering effective community-based first aid training in a remote Aboriginal community required specific adaptations to conventional first aid educational content and pedagogy. Lessons learned: Three key lessons emerged during this program that used collaborative principles to adapt conventional first aid concepts and curriculum: (1) standardized approaches may not be relevant nor appropriate; (2) relationships between course

Rural and Remote Health, 2014

Introduction: Aboriginal people in Canada (First Nations, Inuit and Métis) have a lower health st... more Introduction: Aboriginal people in Canada (First Nations, Inuit and Métis) have a lower health status compared to the Canadian population. There is a particular concern about the mental health and wellbeing of First Nations adolescents living on reserves. Interventions following principles of outdoor education and adventure therapy appear to be an appropriate fit for this population. These approaches have proven effective in non-Aboriginal populations, yet there is very little evidence on the efficacy of these types of program for Aboriginal adolescents. The primary purpose of this study was to evaluate the impact of an outdoor adventure leadership experience (OALE) on the resilience and wellbeing of First Nations adolescents from one reserve community. The secondary purposes were to explore whether this impact was sustainable, and whether there were any intervening factors that may have influenced the impact. Methods: The collaborative research team used a mixed-method design to evaluate the 10-day OALE for adolescents from Wikwemikong Unceded Indian Reserve in northern Ontario, Canada. The main outcome assessed was resilience, measured by selfreport, using the 14-Item Resilience Scale (RS-14). Several other exploratory measures assessed other aspects of health and wellbeing. The questionnaire package was administered at three different time periods: (T1) one day before the OALE; (T2) one month after the OALE; and (T3) one year after the OALE. The Mental Component Score (MCS) of the SF-12v2 was used to confirm any changes in resilience. Open-ended questions were appended to the questionnaire at the 1-year point to identify any intervening © SD Ritchie, M-J Wabano, K Russell, L Enosse, NL Young, 2014. A licence to publish this material has been given to James Cook University, http://www.rrh.org.au 2 factors that may have impacted any changes in resilience and wellbeing. The primary analysis compared mean RS-14 scores at T1 with those at T2. Responses to the open-ended questions were analyzed using content analysis. Results: Over two summers (2009 and 2010), 73 youth 12-18 years of age from Wikwemikong participated in a standardized 10day OALE program. This represented 15% of the on-reserve population of adolescents in this age range. Survey responses from 59 (80.8%) participants were available for analysis at T1, compared to 47 (64.4%) at T2 and 33 (45.2%) at T3. The mean RS-14 score was 73.65 at baseline, and this improved 3.40 points (p=0.011) between T1 and T2. However, the resilience scores at T3 (1 year post-OALE) had a mean of 74.19, indicating a return back to pre-OALE levels. The mean MCS score at T1 was 48.23 and it improved over the subsequent two time periods. Several intervening factors reported at T3 may have influenced the decrease in resilience scores from T2 to T3. These included changes in family living situation, death in the family, and other life stressors that occurred over the course of the year. Conclusions: Outcome scores from this study provide a unique glimpse into the self-reported health and wellbeing for adolescents within one First Nations community in Canada. The OALE program was beneficial in promoting resilience for adolescents in Wikwemikong over the short-term. Future studies are necessary to assess whether the OALE (or similar outdoor type interventions) are effective within other communities.

CJEM, 2018

Introduction: The World Health Organization recommends emergency care training for laypeople in l... more Introduction: The World Health Organization recommends emergency care training for laypeople in low-resource settings, but the effects of these programs on patient outcomes and community health have not been systematically reviewed. Our objective was to identify the individual and community health effects of educating laypeople to deliver emergency care in low-resource settings. Methods: We conducted a systematic review to address this question: in low-resource populations (P), does emergency care education for laypeople (I) confer any measurable effect on patient morbidity and mortality, or community capacity and resilience for emergency health conditions (O), in comparison with no training or other education(C)? We searched 12 electronic databases and grey literature for quantitative studies. We conducted duplicate and independent title and abstract screening, methodological and outcomes extraction, and study quality assessment using the Effective Public Health Practice Tool. We d...

CMAJ Open, 2020

A lmost all residents of Ontario, Canada live within 30 minutes of an emergency department. 1 How... more A lmost all residents of Ontario, Canada live within 30 minutes of an emergency department. 1 However, for about 25 000 Ontarians living in remote commun ities, accessing a doctor in an emergency department requires flying in a plane or helicopter. 1 Patients in these northern com munities access medical care through a local nursing station, with intermittent incommunity physician coverage. Patients with highacuity conditions are transported from remote com munities to hospital by Ornge, the provincial medical air ambulance service provider. 2,3 Even under ideal conditions, these transfers take several hours. Air transports from these communities can face delays due to weather, visibility, mechan ical issues and personnel issues. More than half of the associ ated remote airports do not have key visual aids that pilots use to land aircraft during periods of reduced visibility, which makes medical transports dependent on weather conditions. 4 First Nations populations living in remote communities are known to face challenging social determinants of health: isolated geography, insufficient housing, unemployment, and the cultural impact of colonialism and residential schools. 5 Access to potable water is an issue in many communities, with 188 boil water advisories in First Nations in the Sioux Look out area between 2007 and 2016. 6 These populations face trauma at rates 2.5-8 times greater than the Canadian aver age. 7-10 People living in these communities face elevated rates of chronic disease, which manifest as critical health emergen cies including mental health, infectious disease, diabetic and cardiovascular emergencies. 11-14 The characteristics of patients requiring air medical trans port in this region have not been well described, with only a handful of published papers describing medical emergencies in these remote communities over the last 35 years. 2,6,7,15,16 We aimed to describe who is transported from 26 remote Nish nawbe Aski Nation communities in northern Ontario to access hospitalbased emergency medical care and to describe the primary clinical reason for their transport as stated in the

Canadian Journal of Public Health, 2013

OBJECTIVES: The purpose of this study was to identify concepts of health and well-being important... more OBJECTIVES: The purpose of this study was to identify concepts of health and well-being important to Aboriginal children and youth. These concepts were necessary for the development of a culturally appropriate measure of health. METHODS: We completed 4 community consultation sessions, 4 advisory committee meetings, and 6 full-day focus groups within the Wikwemikong Unceded Indian Reserve. The focus groups engaged Aboriginal children and youth via relevant cultural teachings, a photography exercise combined with a community bicycling tour, and detailed discussions of health and well-being using photovoice. The process was guided by a conceptual model: the Medicine Wheel. The participants placed their photos on a wall mural and identified their most important concepts. These concepts were synthesized through expert consensus into items and reviewed by the broader community. RESULTS: The participants ranged in age from 8.2 to 17.7 years (mean age=12.3). Through innovative methods, children and youth identified 206 concepts representing the 4 quadrants of the Medicine Wheel: emotional, spiritual, physical and mental. These concepts were refocused, in collaboration with the community, to create a new 60-item measure of health and well-being that was primarily positive in focus. CONCLUSION: This study demonstrates the success of implementing a unique process of photovoice in combination with bicycling and informed by an Aboriginal framework. The results confirm the distinct conceptualization of health and well-being in this population and underscore the necessity for a culturally appropriate measure. This study also produced a first draft of the Aboriginal Children's Health and Well-being Measure (ACHWM).

International journal of environmental research and public health, Jan 4, 2018

(1) Background: Remote communities in Canada lack an equitable emergency medical response capacit... more (1) Background: Remote communities in Canada lack an equitable emergency medical response capacity compared to other communities. Community-based emergency care (CBEC) training for laypeople is a model that has the potential to enhance the medical emergency response capacity in isolated and resource-limited contexts. The purpose of this study was to understand the characteristics of medical emergencies and to conceptualize and present a framework for what a medical emergency is for one remote Indigenous community in northwestern Ontario, in order to inform the development of CBEC training. (2) Methods: This study adhered to the principles of community-based participatory research and realist evaluation; it was an integrated component of the formative evaluation of the second Sachigo Lake Wilderness Emergency Response Education Initiative (SLWEREI) training course in 2012. Twelve members of Sachigo Lake First Nation participated in the training course, along with local nursing staff, police officers, community Elders, and course instructors (n = 24 total), who participated in interviews, focus groups, and a collaborative discussion of local health issues in the development of the SLWEREI. (3) Results: The qualitative results are organized into sections that describe the types of local health emergencies and the informal response system of community members in addressing these emergencies. Prominent themes of health adversity that emerged were an inability to manage chronic conditions and fears of exacerbations, the lack of capacity for addressing mental illness, and the high prevalence of injury for community members. (4) Discussion: A three-point framework of what constitutes local perceptions of an emergency emerged from the findings in this study: (1) a sense of isolation; (2) a condition with a potentially adverse outcome; and (3) a need for help.

Journal of Physical Activity and Health, 2010

Background:There has been a recent push in the sport psychology literature for sport participants... more Background:There has been a recent push in the sport psychology literature for sport participants to be approached based on their cultural backgrounds. However, there are few examples where a cultural approach is considered, such as a culturally reflexive version of participatory action research (PAR). In the current study, the role of family is considered in relation to the sport engagement of Canadian Aboriginal youth.Methods:Mainstream researchers teamed with coresearchers from the Wikwemikong Unceded Indian Reserve for 5 years. Community meetings and talking circles were employed as culturally sensitive data collection techniques to uncover how to encourage youth participation in Wikwemikong’s sport programs. The overarching methodology for the project is PAR.Results:Themes and subthemes were determined by community consensus with terms indigenous (ie, culturally relevant) among the local Aboriginal culture. Family was considered important for youth involvement in Aboriginal com...

BMJ open, May 18, 2016

The Disease Control Priorities Project recommends emergency care training for laypersons in low-r... more The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. This systematic review addresses the following question: in underserviced populations and low-resource settings (P), does first aid or emergency care training or education for laypeople (I) confer any individual or community health benefit for emergency health conditions (O), in comparison with no training or other forms of education (C)? We restrict this review to studies reporting quantitatively measurable outcomes, and search 12 electronic bibliographic databases and grey literature sources. A team of expert content and methodology reviewers will conduct title and abstract screening and full-text review, using a custom-bu...

Pathways the Ontario Journal of Outdoor Education, 2011

Connecting through outdoor adventure is a process that may or may not seem obvious. For us, the w... more Connecting through outdoor adventure is a process that may or may not seem obvious. For us, the word "connecting" resonates with a powerful and extensive implied meaning that we feel compelled to share. A recent collaborative research project between leaders from Wikwemikong Unceded Indian Reserve and researchers from Laurentian University helped to uncover, or perhaps rediscover, that meaning through a series of outdoor adventure leadership experiences (OALE) designed for youth from this northern Ontario First Nations reserve (Ritchie et al., 2010). Wikwemikong is a large reserve located at the eastern end of Manitoulin Island in Georgian Bay. The OALE involved a 10day wilderness canoe excursion homeward through the traditional territory of the Wikwemikong community. The route followed the historic French River and then proceeded along the north shore of Georgian Bay towards Killarney and then across the channel to Manitoulin Island. Over two summers nearly 16 percent of the on-reserve population of youth who were between 12 and 18 years of age had completed the program.

Journal of Sport and Social Issues, 2010

Within the motivation literature, it has been indicated that athletes respond more effectively to... more Within the motivation literature, it has been indicated that athletes respond more effectively to sport’s contextual challenges through effective adaptation skills. Fiske identified five core motives as facilitators of the adaptation process across cultures: belonging, understanding, controlling, self-enhancement, and trusting. Through a cultural sport psychology approach, the adaptation challenges and strategies of Canadian Aboriginal adolescent athletes from one community (Wikwemikong) are described as they traveled off reserve to compete in mainstream sporting events. Concurrently, Fiske’s core motives are considered in relation to youth sport participants from the aforementioned Aboriginal community. Culture sensitive research methods among the Wikwemikong, including community meetings, talking circles (TCs), indigenous coding, and coauthoring, were employed in this article. Data are reflected in three themes: (a) challenges pursuing sport outside of the Aboriginal community in ...