Tracey L O'Sullivan

University of Ottawa, Ottawa, Ontario, Canada

Are you Tracey L O'Sullivan?

Claim your profile

Publications (19)18.42 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The EnRiCH Project was formed to address challenges with disaster management for high risk populations. The theoretical foundation is based on salutogenesis, systems theory and community resilience, with emphasis on community assets, social capital, citizen participation, and collaborative practice, which support adaptive capacity to respond and recover from adverse events. We present results from the process evaluation of the use of the structured interview matrix (SIM) facilitation technique as a first step in asset-mapping for a community resilience intervention. Nine SIM sessions were conducted across five geographic communities (n = 143) with professionals and volunteers from emergency management, health and social services, community organisations and citizens who represent high risk populations. Open-ended questionnaires were completed by (n = 139) participants to document experiences of partaking in the session. Content analysis suggests that the SIM is an effective technique to enhance connectedness, common ground, collaborative action, and awareness of existing services and supports in each community. Copyright © 2014 John Wiley & Sons, Ltd.
    Behavioral Science 01/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Complexity is a useful frame of reference for disaster management and understanding population health. An important means to unraveling the complexities of disaster management is to recognize the interdependencies between health care and broader social systems and how they intersect to promote health and resilience before, during and after a crisis. While recent literature has expanded our understanding of the complexity of disasters at the macro level, few studies have examined empirically how dynamic elements of critical social infrastructure at the micro level influence community capacity. The purpose of this study was to explore empirically the complexity of disasters, to determine levers for action where interventions can be used to facilitate collaborative action and promote health among high risk populations. A second purpose was to build a framework for critical social infrastructure and develop a model to identify potential points of intervention to promote population health and resilience. A community-based participatory research design was used in nine focus group consultations (n = 143) held in five communities in Canada, between October 2010 and March 2011, using the Structured Interview Matrix facilitation technique. The findings underscore the importance of interconnectedness of hard and soft systems at the micro level, with culture providing the backdrop for the social fabric of each community. Open coding drawing upon the tenets of complexity theory was used to develop four core themes that provide structure for the framework that evolved; they relate to dynamic context, situational awareness and connectedness, flexible planning, and collaboration, which are needed to foster adaptive responses to disasters. Seven action recommendations are presented, to promote community resilience and population health.
    Social Science [?] Medicine 08/2012; · 2.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Little research has explored emergency preparedness among families coping with stroke. In this longitudinal qualitative study, we explored contingency caregiving planning by interviewing (N = 18) family caregivers providing care for a stroke survivor at home during the first 6 months post-discharge from the hospital. Emergent themes showed most families did not have a concrete "back-up plan" for a crisis or disaster situation involving the primary caregiver being unable to provide care. Furthermore, they assumed formal respite services or long-term care would be available should the need arise. Despite increased awareness over time, most caregivers had not devised contingency plans at 6 months.
    Social Work in Health Care 07/2012; 51(6):531-51. · 0.62 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This article assesses direct costs of integrating a physical activity counselor (PAC) into primary health care teams to improve physical activity levels of inactive patients. A monthly cost analysis was conducted using data from 120 inactive patients, aged 18 to 69 years, who were recruited from a community-based family medicine practice. Relevant cost items for the intensive counseling group included (1) office expenses; (2) equipment purchases; (3) operating costs; (4) costs of training the PAC; and (5) labor costs. Physical and human capital were amortized over a 5-year horizon at a discount rate of 5%. Integrating a PAC into the primary health care team incurred an estimated one-time cost of CA$91.43 per participant per month. Results were very sensitive to the number of patients counseled. The costs associated with the intervention are lower than many other intervention studies attempting to improve population physical activity levels. Demonstrating this competitive cost base should encourage additional research to assess the effectiveness of integrating a PAC into primary health care teams to promote active living among patients who do not meet recommended physical activity levels.
    The Journal of the American Board of Family Medicine 03/2012; 25(2):250-2. · 1.76 Impact Factor
  • Joëlle Levac, Darene Toal-Sullivan, Tracey L O'Sullivan
    [Show abstract] [Hide abstract]
    ABSTRACT: Global policies on disaster risk reduction have highlighted individual and community responsibilities and roles in reducing risk and promoting coping capacity. Strengthening local preparedness is viewed as an essential element in effective response and recovery. This paper presents a synthesis of available literature on household preparedness published over the past 15 years. It emphasizes the complexity of preparedness, involving personal and contextual factors such as health status, self-efficacy, community support, and the nature of the emergency. In addition, people require sufficient knowledge, motivation and resources to engage in preparedness activities. Social networks have been identified as one such resource which contributes to resilience. A predominant gap in the literature is the need for evidence-informed strategies to overcome the identified challenges to household preparedness. In particular, the construct of social capital and how it can be used to foster individual and community capacity in emergency situations requires further study.
    Journal of Community Health 10/2011; 37(3):725-33. · 1.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this paper was to report the physical activity and health outcomes results from the Physical Activity Counselling (PAC) trial. Patients (n = 120, mean age 47.3 ± 11.1 years, 69.2% female) who reported less than 150 min of physical activity per week were recruited from a large community-based Canadian primary care practice. After receiving brief physical activity counselling from their provider, they were randomized to receive 6 additional patient-centered counselling sessions over 3 months from a physical activity counsellor (intensive-counselling group; n = 61), or no further intervention (brief-counselling group; n = 59). Physical activity (self-reported and accelerometer) was measured every 6 weeks up to 25 weeks (12 weeks postintervention). Quality of life was also assessed, and physical and metabolic outcomes were evaluated in a randomly selected subset of patients (33%). In the intent-to-treat analyses of covariance, the intensive-counselling group self-reported significantly higher levels of physical activity at 6 weeks (p = 0.009) and 13 weeks (p = 0.01). There were no differences in self-reported physical activity between the groups after the intervention in the follow-up period, nor was there any increase in accelerometer-measured physical activity. Finally, the intensive-counselling patients showed greater decreases in percent body fat and total fat mass from 13 weeks to 25 weeks. Results for physical activity depended on the method used, with positive short-term results with self-report and no effects with the accelerometers. Between-group differences were found for body composition in that the intensive-counselling patients decreased more. A multisite randomized controlled trial with a longer intensive intervention and follow-up is warranted.
    Applied Physiology Nutrition and Metabolism 08/2011; 36(4):503-14. · 2.01 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper is a report of a qualitative study of emergency and critical care nurses' perceptions of occupational response and preparedness during infectious respiratory disease outbreaks including severe acute respiratory syndrome (SARS) and influenza. Healthcare workers, predominantly female, face occupational and personal challenges in their roles as first responders/first receivers. Exposure to SARS or other respiratory pathogens during pregnancy represents additional occupational risk for healthcare workers. Perceptions of occupational reproductive risk during response to infectious respiratory disease outbreaks were assessed qualitatively by five focus groups comprised of 100 Canadian nurses conducted between 2005 and 2006. Occupational health and safety issues anticipated by Canadian nurses for future infectious respiratory disease outbreaks were grouped into four major themes: (1) apprehension about occupational risks to pregnant nurses; (2) unknown pregnancy risks of anti-infective therapy/prophylaxis; (3) occupational risk communication for pregnant nurses; and (4) human resource strategies required for pregnant nurses during outbreaks. The reproductive risk perceptions voiced by Canadian nurses generally were consistent with reported case reports of pregnant women infected with SARS or emerging influenza strains. Nurses' fears of fertility risks posed by exposure to infectious agents or anti-infective therapy and prophylaxis are not well supported by the literature, with the former not biologically plausible and the latter lacking sufficient data. Reproductive risk assessments should be performed for each infectious respiratory disease outbreak to provide female healthcare workers and in particular pregnant women with guidelines regarding infection control and use of anti-infective therapy and prophylaxis.
    Prehospital and disaster medicine: the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation 04/2011; 26(2):114-21.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Physical Activity Counseling randomized controlled trial integrated a physical activity (PA) counselor into a primary care practice to provide intensive counseling to sedentary patients following brief counseling from their regular health care provider. This article presents the voices of 15 patients, who through a series of 3 interviews, described their experience with this 3-month combined provider PA counseling intervention. Patient satisfaction was a dominant emergent theme, and the patients were particularly positive about the quality of care and educational support for lifestyle change. They favored the tailored approach and felt the strategies for overcoming PA barriers were helpful.
    Journal of Health Psychology 04/2010; 15(3):362-72. · 1.88 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The global impact of severe acute respiratory syndrome (SARS) brought attention to the role of healthcare professionals as "first receivers" during infectious disease outbreaks, a collateral aspect to their role as responders. This article records and reports concerns expressed by Canadian emergency and critical care nurses in terms of organizational and social supports required during infectious disease outbreaks. The nature of work-family and family-work conflict perceived and experienced by nurses during infectious disease outbreaks, as well as the supports needed to enable them to balance their social roles during this type of heightened stress, are explored. Five focus groups consisting of 100 nurses were conducted using a Structured Interview Matrix facilitation technique. Four emergent themes included: (1) substantial personal/professional dilemmas; (2) assistance with child, elder, and/or pet care; (3) adequate resources and vaccinations to protect families; and (4) appropriate mechanisms to enable two-way communication between employees and their families under conditions of quarantine or long work hours. Social and organizational supports are critical to help buffer the effects of stress for nurses and assist them in managing difficult role conflicts during infectious disease outbreaks. These supports are necessary to improve response capacity for bio-disasters.
    Prehospital and disaster medicine: the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation 08/2009; 24(4):321-5.
  • Tracey L O'Sullivan
    [Show abstract] [Hide abstract]
    ABSTRACT: Public resilience, an important determinant of effective disaster management, is dynamic, and families coping with debilitating illnesses, such as stroke or dementia, experience unique vulnerabilities as a result of their caregiving responsibilities. When social networks cannot sustain care, family caregivers turn to formal respite programmes for support. This has tremendous implications on demands for respite services in any disaster response. With an ageing population, the demands for family caregiving are increasing, and more people face the challenges of balancing work and family responsibilities. This includes members of the response community who have family members who need assistance with daily living. Without support, many responders may struggle to fulfil their professional roles, creating a threat to response capacity. Preparedness interventions should focus on building resilience and encourage families to explore possibilities for respite care as well as other standard strategies to ensure self-sufficiency in the early phases of a disaster.
    Radiation Protection Dosimetry 05/2009; 134(3-4):197-201. · 0.91 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Primary care is a promising venue to build patient motivation and confidence to increase physical activity (PA). Physician PA counselling has demonstrated some success; however, maintenance of behaviour change appears to require more intensive interventions. In reality, most physicians do not have the necessary training nor the time for this type of counselling. The purpose of this paper is to outline the rationale, methods, and interventions for the ongoing physical activity counselling (PAC) randomized controlled trial (RCT), which aims to assess the impact of integrating a PA counsellor into a primary care practice. This RCT has 2 arms: (i) brief PA counselling (2-4 min) from a health care provider and (ii) brief PA counselling+intensive PA counselling from a PA counsellor (3 months). The impact of this intervention is being evaluated using the comprehensive RE-AIM framework. One hundred twenty insufficiently active adult patients, aged 18 to 69 y and recruited during regular primary care visits have been randomized. Dependent measures include psychological mediators, PA participation, quality of life, and physical and metabolic outcomes. The PAC project represents an innovative, theoretically-based approach to promoting PA in primary care, focusing on psychological mediators of change. We anticipate that key lessons from this study will be useful for shaping future public health interventions, theories, and research.
    Applied Physiology Nutrition and Metabolism 01/2008; 32(6):1170-85. · 2.01 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Physical Activity Counseling (PAC) trial compared the effects of a 13-week primary care physical activity (PA) intervention that incorporated a PA counselor into a health care practice compared to a control condition on PA over a 25-week period and showed group differences in PA were present at 6 and 13 weeks. The main purpose was to examine the mediating effect of 6-week task and barrier self-efficacy on the intervention versus control group/13-week PA relationships. A secondary purpose was to determine whether task and barrier self-efficacy were significantly related to PA throughout the trial for both groups. Participants were primarily sedentary individuals who received a 2- to 4-min PA intervention from their primary care provider, after which they were randomly assigned to the intervention (n = 61) or control condition (n = 59). Self-reported PA and task (barrier) self-efficacy measures were obtained during (i.e., baseline, 6 and 13 weeks) and after (i.e., 19 and 25 weeks) the intervention in both groups. Six-week task and barrier self-efficacy had a small mediating effect. Furthermore, barrier self-efficacy had a significant relationship with PA throughout the trial, whereas the relationship between task self-efficacy and PA became significantly weaker as the trial progressed. PAC interventions among primarily sedentary individuals should be partly based on barrier and task self-efficacy. However, the stability of the task self-efficacy/PA relationship needs further examination.
    Annals of Behavioral Medicine 10/2007; 34(3):323-8. · 4.20 Impact Factor
  • Source
    Carol A Amaratunga, Tracey L O'Sullivan
    [Show abstract] [Hide abstract]
    ABSTRACT: The psychosocial impacts of disasters are profound. In recent years, there have been too many reminders of these impacts and the dire needs of the people involved. The purpose of this article is to present the following themes from the psychosocial literature on disasters and emergency management: (1) differential impacts of disasters according to gender and age; (2) prevention efforts to reduce racial discrimination, rape, and other forms of abuse; (3) readiness for cultural change toward prevention and preparedness; and (4) the need to involve aid beneficiaries as active partners in relief strategies, particularly during reconstruction of communities and critical systems. Psychosocial needs change throughout the disaster cycle, particularly as social support deteriorates over time. It is important to anticipate what psychosocial needs of the public, emergency responders, support staff, and volunteers might emerge, before advancing to the next stage of the disaster. Particular consideration needs to be directed toward differential impacts of disasters based on gender, age, and other vulnerabilities.
    Prehospital and disaster medicine: the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation 06/2006; 21(3):149-53; discussion 154-5.
  • Prehospital and Disaster Medicine. 04/2005; 20(S1).
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Federal, provincial and municipal leaders in Canada have adopted a culture of preparedness with the development and update of emergency plans in anticipation of different types of disasters. As evident during the 2003 global outbreak of Severe Acute Respiratory Syndrome (SARS), it is important to provide support for health care workers (HCWs) who are vulnerable during infectious outbreak scenarios. Here we focus on the identification and evaluation of existing support mechanisms incorporated within emergency plans across various jurisdictional levels. Qualitative content analysis of 12 emergency plans from national, provincial and municipal levels were conducted using NVIVO software. The plans were scanned and coded according to 1) informational, 2) instrumental, and 3) emotional support mechanisms for HCWs and other first responders. Emergency plans were comprised of a predominance of informational and instrumental supports, yet few emotional or social support mechanisms. All the plans lacked gender-based analysis of how infectious disease outbreaks impact male and female HCWs differently. Acknowledgement of the need for emotional supports was evident at higher jurisdictional levels, but recommended for implementation locally. While support mechanisms for HCWs are included in this sample of emergency plans, content analysis revealed few emotional or social supports planned for critical personnel; particularly for those who will be required to work in extremely stressful conditions under significant personal risk. The implications of transferring responsibilities for support to local and institutional jurisdictions are discussed.
    Canadian journal of public health. Revue canadienne de santé publique 98(5):358-63. · 1.02 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In response to the 2003 global outbreak of severe acute respiratory syndrome (SARS), and the threat of pandemic influenza, Canadian hospitals have been actively developing and revising their emergency plans. Healthcare workers are a particularly vulnerable group at risk of occupational exposure during infectious disease outbreaks, as seen during SARS and as documented/reported in the recent National Survey of the Work and Health of Nurses (Statistics Canada, 2006). Approximately one third of Canadian nurses identified job strain and poor health, related to their work environment. Three years after SARS, this article presents a critical analysis of the gaps of three hospital pandemic influenza plans in the context of established organizational supports for healthcare workers. Hospital pandemic influenza plans were obtained from institutional representatives in three Ontario cities. Qualitative gap analysis of these plans was conducted using a checklist of 11 support categories, developed from a review of existing literature and findings from a previous study of focus groups with emergency and critical care nurses. Support mechanisms were identified in the plans; however, gaps were evident in preparation for personal protective equipment, education and informational support, and support during quarantine. Hospital emergency planning could be more robust by including additional organizational supports such as emotional/psychological support services, delineating management responsibilities, human resources, vaccine/anti-viral planning, recognition/compensation, media strategies, and professional development. Since the 2003 SARS outbreak, hospitals have invested in pandemic planning, as evidenced by the comprehensive plans examined here. Organizational support mechanisms for healthcare workers were included in these hospital plans; however, the gaps identified here may have serious implications for employee health and safety, and overall response during a large scale infectious disease outbreak. The authors provide a number of recommendations for consideration in infectious disease pandemic plan development to better support the healthcare workers in their roles as first responders.
    American journal of disaster medicine 2(4):195-210.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Three years following the global outbreak of severe acute respiratory syndrome (SARS), a national, Web-based survey of Canadian nurses was conducted to assess perceptions of preparedness for disasters and access to support mechanisms, particularly for nurses in emergency and critical care units. The following hypotheses were tested: (1) nurses' sense of preparedness for infectious disease outbreaks and naturally occurring disasters will be higher than for chemical, biological, radiological, and nuclear (CBRN)-type disasters associated with terrorist attacks; (2) perceptions of preparedness will vary according to previous outbreak experience; and (3) perceptions of personal preparedness will be related to perceived institutional preparedness. Nurses from emergency departments and intensive care units across Canada were recruited via flyer mailouts and e-mail notices to complete a 30-minute online survey. A total of 1,543 nurses completed the survey (90% female; 10% male). The results indicate that nurses feel unprepared to respond to large-scale disasters/attacks. The sense of preparedness varied according to the outbreak/disaster scenario with nurses feeling least prepared to respond to a CBRN event. A variety of socio-demographic factors, notably gender, previous outbreak experience (particularly with SARS), full-time vs. part-time job status, and region of employment also were related to perceptions of risk. Approximately 40% of respondents were unaware if their hospital had an emergency plan for a large-scale outbreak. Nurses reported inadequate access to resources to support disaster response capacity and expressed a low degree of confidence in the preparedness of Canadian healthcare institutions for future outbreaks. Canadian nurses have indicated that considerably more training and information are needed to enhance preparedness for frontline healthcare workers as important members of the response community.
    Prehospital and disaster medicine: the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation 23(3):s11-8.
  • Source