Research & Evaluation

Below you will find a curated selection of my research and evaluation projects to date:

    • Examining contextual factors affecting the implementation, scale-up, and sustainability of internet-based testing for STBBIs in BC and ON
    • Defining the scope and challenges of digital public health
    • Assessing the acceptability and validity of risk calculators for internet-based HIV/STI testing
    • Understanding STI testing needs, new testing technologies, and online sexual health services
    • Evaluating processes, partnerships, and program impacts within universities, healthcare systems, and community-based service organizations in BC and ON
    • Supporting the rights and politics of trans sex workers and other street informal vendors in Mexico City
    • Exploring stigmatization in the Vancouver strip and fitness trades

Examining contextual factors affecting the implementation, scale-up, and sustainability of internet-based testing for STBBIs in BC and ON

Objective: This implementation study employed institutional ethnography to examine how context and health equity considerations affect the implementation of innovative online sexual health interventions, like GetCheckedOnline, in BC and ON.

Findings: In BC, this study uncovered the macro-level structural factors shaping internet-based testing services beyond conceptualization and initial implementation (i.e., scale-up, adaptation, maintenance, sustainability). It was found that scale-up was crucially shaped by public health policy. Adaptation was affected by changing technology-related costs and healthcare IT system processes and requirements. Tight, targeted budget envelopes, existing clinical guidelines, and public health responsibilities influenced maintenance. Finally, sustainability was shaped by community and government support and demand for the service and long-term program evaluation. These findings highlighted the significance of turning attention to the later phases of service implementation for a program to adapt, thrive, and survive over time.

In ON, this study uncovered the contextual factors affecting the possible introduction of a service like GetCheckedOnline within a new provincial healthcare system. It was found that existing legislative and political factors regulating the collection and testing of laboratory specimens may present a structural barrier to implementing internet-based testing services in the current form they are delivered in BC. Additionally, existing disparities in how public health labs and outpatient labs are funded in ON must be addressed for existing inequities in access to STBBI testing among gay, bisexual, and other men who have sex with men not to be widened.

Funding: This work was supported by the Canadian Institutes of Health Research, CIHR HIV Trials Network, and Michael Smith Foundation for Health Research.

Dissemination: Results from this work were published in Health & Place, Social Science & Medicine, Critical Public Health, and in a report by the BCCDC’s Digital Sexual Health Initiative.

Defining the scope and challenges of digital public health

Objective: This study investigated what “digital public health,” that is, the integration of digital technologies in public health, means for public health practitioners, researchers, and decision-makers, and to elucidate the scope and framework of this developing field of practice.

Findings: Undertaking a scoping review, this study found that digital technologies have primarily been used for surveillance, health promotion, and public health research purposes. Technical and non-technical challenges (e.g., health equity and ethical issues, data unreliability, technological optimism) must be addressed to integrate digital technologies for public health purposes effectively. The findings from this study point to the need to establish a more cohesive and concerted framework for action in digital public health, as well as systematic critical thinking about how these digital technologies can be fairly, ethically, and equitably employed in public health.

Funding: This work was supported by the BCCDC Foundation for Population and Public Health.

Dissemination: Results from this work were published in Canadian Journal of Public Health, Digital Health, JMIR Public Health and Surveillance, and JMIR Research Protocols.

Assessing the acceptability and validity of risk calculators for internet-based HIV/STI testing

Objectives: These projects examined a) potential users and service providers’ acceptability of online personalized risk self-assessment tools, also known as “risk calculators,” for HIV/STIs, and b) the validity of employing clinical prediction rules derived from in-person STI clinic data to prioritize testing of individuals at highest risk of chlamydia and/or gonorrhea infection in internet-based testing environments.

Findings: Potential users and service providers of online risk calculators conveyed a qualified acceptance of these tools, with recommendations for specific design and content features (e.g., incorporating nuanced risk assessment and tailored educational information, using non-stigmatizing framing and inclusive design, including explanations and actionable next steps) to make these tools useful for education and testing recommendations. Furthermore, the application of clinical prediction rules derived from in-person clinic settings was valid for detecting most infections and reducing unnecessary screening of asymptotic individuals accessing testing in online environments. Risk calculators/clinical prediction rules can provide potential users with educational information and targeted testing recommendations and reduce unnecessary STI testing by optimizing resource allocation.

Funding: This work was supported by the BCCDC Foundation for Population and Public Health and the Canadian Institutes of Health Research.

Dissemination: Results from this work were published in AIDS Education & Prevention and Sexually Transmitted Diseases.

Understanding STI testing needs, new testing technologies, and online sexual health services

Objectives: These studies have aimed to understand a) STBBI testing needs and barriers faced by trans masculine, two-spirit, and non-binary people who are gay, bisexual or otherwise have sex with men, b) the acceptability and implementation of alternative testing services (e.g., virtual interventions, HIV self-testing kits, self-sampling) particularly during the COVID pandemic, and c) sexual and mental health service provision in online sexual health chat services.

Findings: It has been found that cisnormativity and heteronormativity structurally shape the STBBI testing needs of trans masculine, two-spirit, and non-binary people who are gay, bisexual or otherwise have sex with men, and that implementing trans-specific clinical practices that reduce the stigma and barriers faced by these populations in STI testing context is needed. Similarly, alternative models of STBBI testing, such as virtual and self-sampling interventions, were adopted during the COVID-19 pandemic. These interventions were found to be more convenient, accessible, safe, and cost-effective in comparison to clinic-based testing models. At the same time, the enthusiasm for this kind of intervention (e.g., HIV self-testing kits, for example) necessitated clarifications, guidelines, and collaboration for them to be effectively implemented. Lastly, the provision of online sexual health services (e.g., through online sexual health chats) requires identification of mental health (e.g., anxiety) challenges among clients and the appropriate referral and support to meet both mental and sexual health needs.

Funding: This work was supported by the BCCDC Foundation for Population and Public Health and the Canadian Institutes of Health Research.

Dissemination: Results from this work were published in Sexual Health, PLOS ONE, BMC Health Services Research, and in a report by the Pacific AIDS Network.

Evaluating processes, partnerships, and program impacts within universities, healthcare systems, and community-based service organizations in BC and ON

Background: I have been involved in evaluating several projects, processes, and partnerships undertaken by people within universities, healthcare systems, and community-based service organizations in BC and ON.

Projects: Some of these projects I have contributed to include the following:

    • Critical evaluation of the public discourse surrounding the development and implementation of the COVID Alert app as a tool that facilitates potential exposure notifications
    • Rapid review of the BCCDC’s COVID-19 emergency response functions, structure, and ways of working together during the first phase of the COVID-19 pandemic
    • Community-based evaluation of Pacific AIDS Network’s projects concerning new HIV testing technologies, service organizations’ challenges with drug safe supply implementation, and member organizations’ longitudinal views and needs.
    • Evaluation of conference attendees’ satisfaction with the CESBC 2020 Evaluation Conference
    • Developmental evaluation framework for the Ontario Waterloo-Wellington Local Health Integration Network’s Flexible Assertive Community (FACT) Teams
    • Evaluation plan and matrix for the work of the community organization Pain BC
    • Evaluation of the pilot FamilySmart® Practice Readiness Training to address child and youth mental health issues
    • Partnership evaluation of the UBC PLAN 548/Social Innovation Cohort, a university-community organization aimed to build grant funding capacity among community-based service organizations

Significance: Through this work, I have evolved into a mid-career program evaluator interested in highlighting strength-based findings, using evaluation results as learning and growing opportunities, and building evaluation capacity to assess evaluation readiness and community participation.

Supporting the rights and politics of trans sex workers and other street informal vendors in Mexico City

Objective: I conducted a feminist ethnography about on-street sex work and transgender politics in Mexico City. I employed an intersecting critical trans and sexual labour lens to understand the lives and livelihoods of low-income trans street vendors, mostly of sexual services, and the socio-legal demands of mainstream trans activism in contemporary Mexico.

Findings: It was found that the sociopolitical concerns and everyday lives of trans women were shaped by socioeconomic standing and employment background. For many low-income trans women, on-street sex work and informal labour played a central place in their livelihood strategies. But on-street informal sex work was not a significant agenda in formal trans activist demands for legal rights and social recognition. Not only do gender but class and sexual labour concerns should be considered to truly grasp the socioeconomic realities and livelihoods of transpeople in Mexico, particularly of low-income trans women in Mexico City.

Supporting strong transgender politics and organizing in Mexico requires bringing to light precarious informal labour, premature mortality, systemic incarceration, and long histories of street vending work among low-income trans women. Critically, sex workers’ struggles and rights must be supported to advance transpeople’s fight for rights and social justice. The findings from this research pointed toward street vendors as a group of unexpected but possibly promising allies in the struggles for socio-legal recognition of transpeople and sex workers in Mexico.

Funding: This work was supported by Canada’s Social Sciences and Humanities Research Council, UBC Liu Institute for Global Issues, UBC Office of Vice-President Research and International, UBC Go Global, UBC Faculty of Arts, and UBC Department of Anthropology.

Dissemination: Results from this work were published in Género y Salud en Cifras, Irish Journal of Anthropology, and DFensor: Revista de derechos humanos, and in the UBC cIRcle Repository.

Exploring stigmatization in the Vancouver strip and fitness trades

Objectives: These studies focused on a) the intersections between the strip and fitness trades in the form of pole dancing classes and b) the state regulation and stigmatization of adult entertainment recruiters on post-secondary campuses.

Findings: Results from these studies showed that the prospect of acting like, but not being, strippers or exotic dancers titillated non-sex worker women when signing up for fitness pole dancing classes. The effects of the “whore stigma” on pole-dancing students meant that non-sex worker women actively distanced themselves and their exercise of amateur pole dancing from the tarnishing images associated with the strip and sex trades. Similarly, the systemic and widespread legal, social, and symbolic repudiation of sex work, sex workers, and people presumed to be or act like sex workers translated into the stigmatization and attempted regulation of adult entertainment industry recruiters and workers by state actors in BC university campuses. The protective paternalism offered to young women suspected of becoming student sex workers, however, did not translate into meaningful action for affordable university tuition models. Furthermore, discussions around adult entertainment recruiters did not involve protection from the harassment faced in other employment sectors actively recruiting student workers on university campuses.

Funding: This work was supported by the UBC Faculty of Graduate Studies.

Dissemination: Results from this work were published in Canadian Theatre Review and in the UBC cIRcle Repository.

Last updated: November 22, 2022.