Publications of 2025
Kishana Balakrishnar, Bao-Zhu Stephanie Long, Luke A. Fiorini, Aaron Howe, Ali Bani-Fatemi, Basem Gohar, Behdin Nowrouzi-Kia
There has been a significant rise in telework since the onset of the COVID-19 pandemic. Telework offers several benefits, such as greater flexibility and increased productivity. It also presents challenges such as increased after-hours work, which can negatively impact workers' physical and mental wellbeing. This scoping review aims to identify the antecedents of after-hours work among teleworkers. Online databases, including Medline via OVID, Embase via OVID, APA PsycINFO via OVID, International Bibliography of Social Sciences (IBSS) via ProQuest, Sociological Abstracts via ProQuest, Business Source Premier via EBSCOhost, and CINAHL via EBSCOhost will be searched to gather literature on factors affecting after-hours work among teleworkers. The inclusion criteria include study participants aged 18 or older, part of the working population, and individuals teleworking for at least six months. Additionally, the studies must be empirical, peer-reviewed, discuss the antecedents of after-hours work, and be published from 2010 to 2024. The findings from this study will guide organisations and healthcare professionals in developing strategies to reduce after-hours work among individuals who telework, thereby improving their overall health and wellbeing. The registration number for this scoping review on Open Science is (DOI 10.17605/OSF.IO/6A7M9).
Behdin Nowrouzi-Kia, Zahi Touma, Antonio Avina-Zubieta, Mary Fox, William Shaw, Maggie Ho, Qixuan Li, Catherine Ivory, Paul Fortin, Stephanie Keeling, Jennifer Reynolds, Derek Haaland, Janet Pope, Lily Lim, Murray Urowitz, Laura Whittall Garcia and Dafna Gladman
Research studies from different countries have shown that variations in the relationship between some occupational factors and mental health and stress exist. Studies that have investigated this relationship within the Canadian population are limited. The objective of this study was to explore the relationships between the number of working hours, occupation, employment type, sex, and age on mental health and stress. Multivariable and univariate ordinal logistics regression models were applied to the 2017–2018 Canadian Community Health Survey (CCHS) dataset to investigate the associations that may exist between perceived mental health and stress, self-rated variables on a Likert scale, and various occupational factors. When compared to respondents who worked 31–40 h per week, those working 1–10 (OR = 1.20, p < 0.001) and 11–20 (OR = 1.19, p < 0.001) hours per week were more likely to have worse mental health. However, the 1–10 and 11–20 h worked per week groups were 26% and 17%, respectively, less likely to have higher stress compared to the group working 31–40 h per week. Mental health and stress were found to be associated with occupation group, employment type, age, and sex. This study provides evidence on how occupational factors impact mental health and stress within the Canadian population, for which there is a dearth of research on.
​Caroline Dignard, Michel Larivière, Behdin Nowrouzi-Kia, Nancy Lightfoot, Zsuzsanna Kerekes & Line Tremblay
Consequences of poor mental health in the workplace are well documented, but mental health research specific to the mining industry remains scarce, especially in Canada. Findings are nonetheless compelling, as they seem to reflect higher rates of mental health-related symptoms among mining workers. The objective of this paper is to determine the symptom prevalence of stress, anxiety, and depression among a sample of Canadian mining workers and to identify demographic, psychosocial, and health-related, and work-related factors associated with stress, anxiety, and depression for these workers. 2224 mining workers across 25 worksites at one company in Ontario, Canada completed a self-reported questionnaire. The prevalence of depression symptoms (12.5%) and anxiety (5.9%) in this sample was found to be higher than in the working-age Canadian population, and multiple regression analyses revealed many shared predictors for stress, anxiety, and depression symptoms. The demographic, psychosocial and health-related predictors can be classified into four main categories: (1) individual characteristics, (2) interpersonal relationships, (3) lifestyle, and (4) the overlap between physical and mental health. Work-related predictors were also grouped into four categories: (1) work schedule and demands, (2) effort-reward imbalance and recognition and reward, (3) job insecurity and job satisfaction, and (4) the physical and psychological work environment. The findings illustrate the importance of recognizing the multidimensionality of health: mental health problems are undoubtedly the result of a number of interrelated factors, which include mental, physical, and social components, in addition to demographic and workplace-specific factors.
​Anson Kwok Choi Li, Jennifer Casole & Behdin Nowrouzi-Kia
Research studies from different countries have shown that variations in the relationship between some occupational factors and mental health and stress exist. Studies that have investigated this relationship within the Canadian population are limited. The objective of this study was to explore the relationships between the number of working hours, occupation, employment type, sex, and age on mental health and stress. Multivariable and univariate ordinal logistics regression models were applied to the 2017–2018 Canadian Community Health Survey (CCHS) dataset to investigate the associations that may exist between perceived mental health and stress, self-rated variables on a Likert scale, and various occupational factors. When compared to respondents who worked 31–40 h per week, those working 1–10 (OR = 1.20, p < 0.001) and 11–20 (OR = 1.19, p < 0.001) hours per week were more likely to have worse mental health. However, the 1–10 and 11–20 h worked per week groups were 26% and 17%, respectively, less likely to have higher stress compared to the group working 31–40 h per week. Mental health and stress were found to be associated with occupation group, employment type, age, and sex. This study provides evidence on how occupational factors impact mental health and stress within the Canadian population, for which there is a dearth of research on.
Behdin Nowrouzi-Kia, Sharada Nandan, Edris Formuli, Kishana Balakrishnar, Ali Bani-Fatemi, Aaron Howe, Yiyan Li, Luke A. Fiorini, Shane Avila, Chantal Atikian, Kathy Zhou, Mahika Jain, Basem Gohar
Many organizations have shifted to hybrid or remote work arrangements in response to the COVID-19 pandemic. Illness, whether physical or psychological, can manifest during telework (remote or home-based work), leading to presenteeism and absenteeism behaviour. However, varying definitions of presenteeism and absenteeism have made measuring presenteeism, absenteeism, and their antecedents increasingly challenging. This scoping study seeks to define presenteeism and absenteeism in the (tele)workplace and systematically identify the factors contributing to their occurrence. A systematic literature search was performed on seven online databases: MEDLINE, CINAHL, PsycINFO, ABI Inform Global, SCOPUS, Web of Science and Business Source Premier. We applied the PRISMA-ScR guidelines and Joanna Briggs Institute framework to systematically collect, identify, and report studies. The inclusion criteria encompassed studies with participants aged 18 to 65 years old who currently work in a telework environment for at least 50% of their work hours. Of 826 initially identified studies, 18 studies were included after screening (11 quantitative, three qualitative and two mixed-methods studies). A total of 26,805 workers were included in this review across 16 empirical studies. Overall, presenteeism is defined as working while ill, and absenteeism is known as being absent from work or taking sick leave. We identified three major categories for the antecedents of presenteeism and absenteeism behaviour: organizational (i.e., job demand and telework), environmental (i.e., work and home environment), and individual (i.e., poor mental health and job perception). Presenteeism and absenteeism among teleworkers manifest from organizational, environmental, and individual forces that lead to working while sick, or being absent from work, respectively. We found that each of these antecedents relates to one another through the social determinants of health framework. Our conceptual findings guide developing top-down organizational policies and strategies that address presenteeism and absenteeism behaviour, particularly in telework settings.
Background: Systemic lupus erythematosus (SLE) disease symptoms that can significantly restrict work ability and work participation resulting in reduced mental well-being. This study investigates the significant impact of work participation and disability on the mental wellbeing, health-related quality of life, and disease-related outcomes in individuals with SLE.
Methods: With the objective of creating an SLE-related functional profile rooted in work disability (WD) prevention, 46 SLE patients were purposively recruited from Canadian medical centres. Through semi-structured interviews guided by a WD prevention framework, factors associated with WD and lived experiences of SLE-related WD were qualitatively explored. Braun and Clarke’s six-stage inductive thematic analysis was used to organize the data.
Results: Most participants experienced some form of work disability across their employment history related to their clinical manifestations of SLE, including hospitalizations, physical limitations, fatigue, and neurocognitive symptoms (e.g. brain fog). Thematic analysis revealed three key themes: (a) the influence of illness experience on work, (b) the stigmatization of illness disclosure, and (c) the availability of workplace resources/accommodations. Participants emphasized the desirability of work with reduced physical and mental demands, increased personal control, and workplace flexibility to prevent WD.
Conclusion: The study underscores the need for a collaborative, multi-component, and multidisciplinary intervention targeting psychosocial and workplace factors to establish a goal-oriented preventative framework, potentially improving WD outcomes in SLE individuals.
Kishana Balakrishnar, Bao-Zhu Stephanie Long, Alexia M. Haritos, Edris Formuli, Behdin Nowrouzi-Kia
Background: The increased demands and stressors from the COVID-19 pandemic led to widespread burnout and job stress, prompting concerns about retention rates. This study identifies demographic and occupational predictors of Canadian nurses’ intent to leave their jobs due to burnout and job stress during the COVID-19 pandemic.
Methods: Data was utilized from the Survey on Health Care Workers’ Experiences During the Pandemic conducted by Statistics Canada. Multivariate logistic regression models were generated to analyze the associations between demographic and occupational factors and nurses’ intent to leave.
Results: A total of 12,246 eligible participants responded to the survey (54.9% response); however, the analysis was restricted to 1138 nurses after excluding participants of other healthcare occupations. Younger nurses were significantly more likely to consider leaving their jobs [OR = 9.95, 95% CI: (5.92–16.73)], as well as nurses living in Alberta [OR = 3.16, 95% CI: (1.58–6.32)] and British Columbia [OR = 3.16, 95% CI: (1.66–6.03)]. Moreover, nurses with less work experience [OR = 3.91, 95 CI = (2.53–6.05)], work in acute care [(OR = 3.31, 95 CI = (1.69–6.51)], experienced changes in workload [OR = 2.69, 95% CI: (1.58–4.57)], had increased work hours [OR = 1.92, 95% CI: (1.27–2.92)], and lacked emotional support [OR = 3.43, 95 CI = (2.31–5.09)] had greater odds of intending to leave.
Conclusion: The findings underscore the need for strategies to mitigate stress and burnout among nurses, particularly during public health crises. Implementing measures to address these factors could help improve retention rates and ensure a stable nursing workforce during future pandemics.
Objective: This scoping review aims to comprehensively explore the facilitators and barriers influencing the return to work (RTW) process following a concussion, with a focus on the person impacted by concussion, medical system, funder, and workplace domains.
Design: A scoping review of electronic databases, including CINAHL, Embase, MEDLINE, PsycINFO and Web of Science, was conducted to identify relevant studies published up to April 6, 2024. Studies were included if they examined factors influencing RTW following a concussion and were available in English. Data extraction, numerical analysis and deductive content analysis were performed to determine key themes from the data. Reporting guidelines provided by the PRISMA-ScR were adhered to, and the protocol has been registered and can be accessed at the Open Science Framework.
Results: Twenty studies met the inclusion criteria and were included in the review. Findings were organized into 4 main themes influencing the RTW process: the person impacted by concussion, medical system, funder, and workplace. These were further categorized into 2 subthemes: supportive elements and challenges. Various supportive elements within each theme were identified, such as individualized rehabilitation services, graduated return to work, and developing personal agency in the individual impacted by concussion. Challenges such as lack of patient education, delayed access to services, and isolating workplace accommodations were highlighted. These findings underscore the complex interplay of factors shaping the RTW trajectory post-concussion.
Conclusion: This scoping review provides a detailed examination of supportive elements and challenges in the RTW process following a concussion. The identified themes offer valuable insights for clinicians and researchers seeking to optimize RTW outcomes and support individuals re-entering the workforce after a concussion. Future research should prioritize an examination of relevant policies and practices, assessing long-term outcomes, and explore strategies to integrate support systems to enhance the RTW experience.
Objective: To identify candidate Systemic Lupus Erythematosus (SLE) domains from the literature for consideration towards the development of the SLE Core Outcome Set.
Methods: This was a comprehensive scoping literature review of SLE clinical trials and systematic reviews published since 2010. Studies were identified from 5 databases and were screened for eligibility. Candidate domains were extracted from the included studies. Candidate domains were winnowed and binned by the Outcome Measures in Rheumatology (OMERACT) SLE Advisory Group.
Results: Of the 4063 studies identified, 507 met inclusion criteria and proceeded to data extraction. Multiple domains and items were extracted, which winnowing and binning reduced to 25 candidate domains.
Conclusion: The 25 candidate domains cover the important aspects of SLE and the 4 core areas of disease impact according to OMERACT framework. The 25 candidate domains constitute a feasible and manageable number of domains to proceed with to the core domain consensus stage that covers the wide range of impact of SLE. The candidate domains will be supplemented by ongoing qualitative research with patients living with SLE to identify additional domains before proceeding to the consensus stage.
Purpose: Homecare rehabilitation professionals (hcRPs) play a critical role in promoting client independence and health management in home and community settings. However, the COVID-19 pandemic has exacerbated burnout, mental health challenges and occupational stress among hcRPs, negatively affecting job satisfaction, care quality and job retention. This study aims to examine factors influencing job satisfaction among Canadian hcRPs transitioning out of the pandemic.
Design/methodology/approach: This study is part of a larger mixed-methods research project investigating burnout and occupational stress in hcRPs. Quantitative data were collected through self-reported questionnaires from a sample of 100 English-speaking hcRPs employed by a large home care organization. Descriptive analyses were conducted, and two logistic regression models were developed: one analyzing demographic predictors and the other focusing on occupational experiences.
Findings: Higher levels of social and supervisory support and lower work stress were significantly associated with greater job satisfaction. These results underscore the importance of targeted workplace interventions to enhance social and supervisory support and implement stress-reduction measures.
Originality/value: This study provides evidence-based insights into the predictors of job satisfaction for hcRPs, an often-overlooked workforce facing unique challenges post-COVID-19. By addressing these factors, organizations can develop effective strategies to improve job satisfaction, enhance care quality and reduce turnover. Future research should investigate causal relationships and the role of job control in hcRPs’ job satisfaction.
Bao-Zhu Stephanie Long, Kishana Balakrishnar, Maryna Mazur, Elana Maria, Kathleen Hennessy, Mathew Rose, Behdin Nowrouzi-Kia
Objective: This study aims to explore how occupational therapists working in private practices in Canada use clinical indicators and tools to determine if clients require 24-hour attendant care.
Design: A qualitative research study.
Setting: The setting involved semi-structured, one-on-one interviews with occupational therapists in Canada.
Participants: Occupational therapists were selected through purposive sampling: (1) registered Canadian occupational therapists, (2) with over 10 years of private practice experience, and (3) who have assessed the need for 24-hour attendant care at least once before the study.
Main measures: The interviews were conducted, transcribed, coded, and thematically analyzed by two researchers using Braun and Clarke's protocol. The paper is also reported based on the consolidated criteria for reporting qualitative research guidance.
Results: The study involved nine occupational therapists (eight women and one man), with 14 to 24 years of private practice experience in Ontario. Three main themes in the decision-making process for 24-hour attendant care were identified: (1) Individualized and Holistic Assessments; (2) Clinical Expertise-Based Decision-making; and (3) Risk Assessment in Decision-Making.ConclusionsThis study provides a greater understanding of the decision-making process of occupational therapists working in Canada when recommending 24-hour attendant care. However, further research and development of guidelines are needed to support occupational therapists in this area.
Mary T Fox, Jeffrey I Butler, Adam M B Day, Evelyne Durocher, Sherry Dahlke, Mark W Skinner, Behdin Nowrouzi-Kia, Janet Yamada, Ilo-Katryn Maimets
Introduction: Prior research has identified that older rural patients and their families view preparation for detecting and responding to worsening health after a hospital stay as their most pressing unmet need, and perceive an evidence-based warning signs intervention that prepares them to do so as highly likely to meet this need. Yet, little is known about healthcare professionals' perspectives about potential barriers and facilitators to implementing warning signs interventions, especially in rural communities.
Aim: This study aimed to identify potential barriers and facilitators to healthcare professionals' provision of a warning signs intervention in rural communities.
Materials and methods: In this qualitative descriptive study, we examined healthcare professionals' perspectives on potential barriers and facilitators to providing a warning signs intervention. A purposive, criterion-based sample of healthcare professionals, stratified by professional designation (three strata - nurses, physicians, and allied healthcare professionals) who provide health care to rural dwellers in Ontario, Canada participated in semi-structured telephone focus-group discussions or 1:1 interviews on barriers and facilitators to delivering the intervention. Data were analyzed using conventional qualitative content analysis.
Results: Twenty-seven healthcare professionals participated in focus groups and 15 in 1:1 interviews for a total of 42 healthcare professionals. Analysis by healthcare professional stratum revealed nine categories of barriers and facilitators: material resources; human resources; healthcare professional communication; healthcare professional knowledge and skill; healthcare professional buy-in; context of rural practice; patient- and family-specific characteristics; risks and liabilities; and timing of intervention delivery. Seven of these categories converged across healthcare professional strata. However, the reasons why different healthcare professional strata perceived the categories as important, and the ways in which they saw them functioning as barriers and facilitators, varied. Our findings shed light on barriers and facilitators that should be considered to ensure successful implementation of the intervention in rural communities.
Discussion: This study adds to the limited research on rural healthcare professionals' perspectives on barriers and facilitators to delivering a warning signs intervention.
Jessica DeMars, Quentin Durand-Moreau, Erin Branton, Behdin Nowrouzi-Kia and Douglas P. Gross
The editorial highlights that the condition's heterogeneous, fluctuating, and unpredictable symptoms, particularly post-exertional symptom exacerbation (PESE), pose significant challenges for working adults and traditional return to work (RTW) processes. It argues that conventional occupational rehabilitation approaches with rigid timelines are ineffective and that insurers and employers often hold unrealistic expectations. The editorial advocates for prolonged, flexible, phased, or gradual RTW, including potential permanent accommodations, guided by a 'Do No Harm' principle that carefully tailors interventions to symptoms. Crucially, it stresses that the worker with Long COVID should be central to the process, with a focus on their lived experience and function over potentially misleading objective findings. The article also points to the need for systemic changes, like moving away from 'all or none' disability models, and further research into tailored care pathways and symptom trajectories.
Gabriela Castañeda Millan, Alexia Haritos, Edris Formuli, Maryna Mazur, Kishana Balakrishnar, Bao-Zhu Stephanie Long, Behdin Nowrouzi-Kia
A recent publication investigating the predictors of and barriers to mental health help-seeking among healthcare workers amidst the COVID-19 Pandemic.
Shane Avila, Yifan Hao, Ali Bani-Fatemi, Aaron Howe, Behdin Nowrouzi-Kia
A recent publication studying individuals with arthritis and the effects it has on both their personal and professional lives.
Behdin Nowrouzi-Kia, Leslie Carlin, Andrea D. Furlan, Shireen Harbin, Colette N. Severin, Emma Irvin, Nancy Carnide, Aaron Thompson, Anil Adisesh
A recent publication investigating the needs, barriers and facilitators that impact primary care providers in supporting patients' stay-at-work and return-to-work efforts following injury or illness.