Aleksandra Stanimirovic of the University of Toronto is currently conducting a study that underscores the rationale behind her decision to become a health researcher, not a doctor.
The project focuses on a screening program for diabetic retinopathy – a complication of diabetes that can lead to blindness – in women from lower socioeconomic groups.
She hopes that her work will help affected women identify changes in their vision early on so that they can receive appropriate care.
“As a clinician, I thought that my effects were somewhat limited to my patients, while my effects, which I now focus on policy changes, for example, could be wider,” says Stanimirovic, now a contributing doctoral student at the Institute for Health Policy, Management and Management evaluation (IHPME) from the University of Toronto at the Dalla Lana School of Public Health.
“I can influence the results not only of patients, but also of their carers and researchers.”
Stanimirovic, who is also a postdoctoral fellow in the health systems and technology evaluation program at the Toronto General Hospital Research Institute and a trainee in Diabetes Action Canada’s CIHR SPOR network, says early detection and treatment of diabetic retinopathy can prevent the greatest loss of vision . However, she notes that there is an inverse relationship between screening, income, and gender. For example, research shows that women from lower socioeconomic groups are less likely to be screened for breast cancer and colon cancer.
Stanimirovic will study those who participated in a Teleretina program that allowed users at the South Riverdale Community Health Center in downtown Toronto to be screened for diabetic retinopathy via a mobile clinic between 2014 and 2019. The Toronto Teleretina Screening Program was designed to address difficulties in maintaining vision screenings in Canadians with diabetes. It is aimed at low-income communities with a high prevalence of diabetes and low screening rates for diabetic retinopathy.
A previous study, led by Stanimirovic and her supervisor, Valeria Rac, showed the program was a more cost-effective method of screening than the standard of care in disadvantaged communities. Previous research was cited which found that 37 percent of participants in the program had never had an eye exam and 27 percent of the cohort studied were diagnosed with diabetic retinopathy.
“When looking at women in lower socio-economic groups, diabetics usually have multiple health problems and very limited resources,” says Stanimirovic. “This hinders their chance of achieving health equity, ie access to health resources.
“There is more than one factor that overlaps to create this health inequality challenge. This can be age, gender, ethnic background, etc. They all come together and create a state of health inequality. The oppression does not come from a factor; It comes from the intersectionality of all of these factors that we call social determinants of health. “
According to Rac, an assistant professor at IHPME, it is important to look at the design, implementation and evaluation of health interventions with the intersectionality framework. “I want to make this lens food for thought if you are planning to implement a new program. How does this program affect justice and access to care for women, people from lower socio-economic groups, or people from particular cultures or races?
“We have to give it a lot of thought when we bring something new to the industry [health] System.”
Stanimirovic will investigate how many people from the South Riverdale Community Health Center – some of whom do not have Ontario health insurance – were referred for screening, how many people did, and what the results of the screening were. She will find differences in referral and screening rates between men and women.
The study also has a qualitative aspect, speaking with patients, care providers and administrators of the Teleretina program to get feedback on what is working and how it can be improved.
By understanding the barriers and easements to screening, Stanimirovic hopes to develop engagement strategies that are more culturally appropriate for specific groups.
“We want to understand from those who identify as women: What are the barriers to screening? Is it because they take care of children? Maybe they are not aware [the program] exists? Maybe they have competing priorities? We hope that the thematic analysis will support us in the cultural transformation of this initiative, ”says Stanimirovic. “Research has shown that cultural components are critical to the success of community implementation.”
According to Stanimirovic, the goal is to increase screening rates for diabetic retinopathy in the study population in order to detect changes in vision early so that people can receive appropriate care. More than three million people in Canada have diabetes. by 2025 that number will rise to five million.
“I don’t want to be [naïve] and think everyone will be checked, but even small steps can significantly improve the quality of life, ”says Stanimirovic. “I want this to be an intervention that is tailored to their needs and context, with the hope that it will improve their quality of care and quality of life.”
The research is supported by an internship award from Diabetes Action Canada.