The Bridge Engagement Centre (The Bridge)

Overview

The Bridge is a community-based research centre located in downtown Ottawa. Under the direction of Dr. Smita Pakhale, The Bridge was established to improve quality of life of the people in a community-based participatory action research (CBPAR) framework, which emphasis a true partnership with the target population: The urban poor population, including people who self-identify as: homeless, at-risk for homelessness, low-income racialized including Indigenous peoples.  

Our goal is to co-create and investigate innovative evidence based sustainable solutions addressing the root causes of poor health – namely isolation, mental illness, poverty, and trauma. Ultimately, we aim to realize the full potential of people and improve the health and well-being of communities, leaving no one behind, in addition to reducing health care system costs.

The Bridge Highlights

• The Bridge uses a Patients First approach to ensure the meaningful partnership/engagement of people with lived experience
• The Bridge has demonstrated that it is feasible to engage, recruit, train, and retain community peer researchers truly representative of the target population and project participants representative of the target population
• The Bridge conducts rigorous mix-method research, including two pragmatic, multi-site RCTs focusing assessing an intervention designed to improve the Quality of Life (QoL).
• Current team members: Smita Pakhale, Community Peer Researchers (Johnathon B., Adar S., Max M., Terry H., Vanessa F, Meghan H.), Sadia Jama (PhD student), Bruna Falavinha (PhD student), Deidre Riordon (NP and Sr Program Manager), Maryam Rizvi (Coordinator), Aaron Cowan (Methodologist), Randa Hasan (RA), along with many medical students, residents and fellows.

Areas of Research

Community Based Participatory Action Research (CBPAR)

The Bridge operates under a Community-Based Participatory Action Research (CBPAR) framework. CBPAR is an alternative approach used to address the various health issues that disproportionality impact the urban poor population. Using this approach, researchers aim to tackle issues that are related to community health improvement and knowledge translation through developing an equitable partnership with community stakeholders. This approach has shown to contribute to program improvement, including greater efficiency, cultural and local sensitivity, sustainability and a decreased dependency on health professionals. 

Briefly, this approach is operationalized on every level at The Bridge. Firstly, community peer researchers, people with lived experience, are actively involved in the research process from end-to-end: concept, design, and implementation to knowledge translation. Secondly, The Bridge has a Community Advisory Committee (CAC), where people from the local community are voting members and representatives of the neighborhood organizations are the non-voting members. The Bridge CAC meets regularly to oversee all the projects at the Bridge and the mission and vision of the Bridge. Finally, The Bridge organizes quarterly peer-designed and peer-led ‘Community Knowledge Forums’ where all partners, funders, peers and participants partake in a lively discussion.

Related Publications: 

• https://researchinvolvement.biomedcentral.com/articles/10.1186/s40900-016-0034-y

Addressing the Tobacco Inequity

Passionate about lung health and health equity, Dr. Pakhale has always directed attention to the issue of smoking. While tobacco use rate in Canada is 18%, Ottawa boasts the lowest rate at 9-12%. However, our recently completed PROUD Study (Participatory Research in Ottawa: Understanding Drugs: The PROUD Study [Pakhale-co-I] uncovered an extreme tobacco inequity: the urban poor population of Ottawa has tobacco use rate of 96%. It was clear that, while high profile illnesses such as HIV/AIDS and hepatitis-C generated impetus for our PROUD study, tobacco had a bigger impact on morbidity, mortality and healthcare costs in this population. 

When presented to the community, members showed a stronger desire to address this inequity. As such the Management and Point-of-Care for Tobacco Dependence (PROMPT) research project was designed and implemented. The whole-person, compassionate approach at the Bridge demonstrated unexpected downstream positive outcomes in this project. Despite providing ONLY support towards tobacco dependence, majority participants reduced/quit tobacco use, and also reduced/quit all other drug use including opioids like fentanyl. Over third of the participants improved their general socio-economic status by reuniting with their family, getting a better place to live, a better job, a pet, school and drug rehab enrolments.

Related Publications:

• https://bmjopen.bmj.com/content/8/1/e018416
• https://researchinvolvement.biomedcentral.com/articles/10.1186/s40900-018-0125-z

Media Coverage:

• https://ottawacitizen.com/news/local-news/egan-how-to-get-street-people-off-drugs-get-them-off-smokes-study-suggests
• https://ottawacitizen.com/news/local-news/breaking-tobacco-habit-among-homeless-cuts-opioid-use-ottawa-study-finds
• https://www.cbc.ca/news/canada/ottawa/ottawa-hospital-research-smoking-opioids-1.4498597
• https://cusjc.ca/catalyst/project/community-effect-dr-smita-pakhale/

Healthy People Initiative

A multi-site Randomized Control Trial funded by CIHR and PHAC, the 'Healthy People Initiative (HPI)" Project, is currently underway at the Bridge. Projects at the Bridge investigate the root causes of poor health and propose innovative solutions that can improve health, well-being and the QoL of vulnerable individuals and communities. These projects also seek to address societal and structural barriers as well as individual challenges with legal, social, and healthcare system utilization due to poverty, isolation, stigma, discrimination, racism, intergenerational trauma, and mental health and substance use disorders. The main objective of the HPI project is to improve the QoL of people, as defined by them.


COVID Impact Project


Dr. Pakhale is spear heading the COVID Impact Project at the Bridge, learning the impacts of this pandemic on the Bridge population, with peer-reviewed funding from CIHR, Ministry of Health Ontario, and the TOHF-OHRI COVID-19 Hub. Community peer researchers co-designed the project, recruited 400 participants despite the ongoing COVID-19 restrictions, following all Public Health guidelines and and administered surveys to collect data on various aspects of participants' lives including vaccine hesitancy. Community peers also completed 30 semi-structured interviews. We are currently analyzing this rich, patient-centered data.

Media Coverage:

* The Ottawa Citizen article (1st Feb 2021): https://ottawacitizen.com/opinion/pakhale-covid-19-challenges-us-to-decide-which-is-more-important-community-or-self
* CBC live radio interview (15th Jan 2021): https://www.cbc.ca/listen/live-radio/1-92-all-in-a-day/clip/15819018-effects-pandemic-ottawas-vulnerable-population
* CBC live radio interview (6th Nov 2020): https://www.cbc.ca/listen/live-radio/1-100/clip/15807302 (Ontario COVID19 Budget, 2020)
Ontario Newsroom (21st May2020): https://news.ontario.ca/opo/en/2020/05/ontario-announces-first-phase-of-research-projects-to-fight-covid-19.html
* CBC live radio interview (13th May 2020): https://www.cbc.ca/listen/live-radio/1-92-all-in-a-day/clip/15776346-how-are-ottawas-most-vulnerable-residents-being-affected-by-the-pandemic
* https://www.ctvnews.ca/video?clipId=1964299

Other Ongoing and Upcoming Projects

Building off the success of PROMPT and input from the urban poor population, Dr. Pakhale has received two major CIHR grants to conduct two multi-site (Ottawa and Toronto) RCT:

1) Named the ‘Healthy People Initiative’ (HPI), this RCT is looking into the feasibility of a social-network based intervention in the urban poor population, specifically those at-risk for HIV/AIDS. Currently ongoing, the Toronto site is expected to launch later this year.

Media Coverage:

• https://capitalcurrent.ca/breaking-barriers-new-ottawa-study-empowers-at-risk-community/
  

2) The second RCT will be assessing the use of electronic cigarettes as a tool in treating tobacco dependence and the electronic cigarette’s overall impact on a smoker’s quality of life. This project is expected to start early next year.

Media Coverage:

• https://ottawacitizen.com/news/local-news/a-new-clinical-trial-in-ottawa-asks-can-e-cigarettes-help-the-homeless-quit-smoking
• https://www.cbc.ca/news/canada/ottawa/ottawa-hospital-cigarettes-tobacco-homeless-1.4412474

Other Research

Dr. Pakhale was an active member of the Tobacco Action Committee of the American Thoracic Society (ATS) for over a decade since 2011 (Graphic Warning Labels on Cigarettes-Annals of ATS 2013). The committee recently completed working on a harm reduction Statement on tobacco and published it in the ARJCCM (2018). This comprehensive statement will serve as a guide to researchers, policy makers and public to promote much needed framework around 'harm reduction' especially in tobacco research. The committee published an official ATS Tobacco Research Statement in ARJCCM in 2015 and also completed working on ' ATS Tobacco Dependence Management Guidelines' published in ARJCCM in 2020. Dr. Pakhale is also worked on development of the ATS Policy on Research Funding from marijuana companies.

Dr. Pakhale has published several landmark research studies on bronchial asthma, cystic fibrosis (CF), lung transplantation, in addition to the community-based work at the Bridge:   

• The first study to identify a novel long-term complication of lung transplantation, upper lobe fibrosis, which later came to be known as ‘Restrictive Allograft Syndrome (RAS)’  (AJR 2004 and JHLT 2005)   
• A patient partnership/engagement study investigating the prevalence of bronchial asthma in grade 7- and 8 students from rural India, showing for the first time a similar level of asthma and wheeze prevalence in rural and urban populations (J of Asthma 2008).
• The first paper to uncover the stigma associated with cystic fibrosis using a meaningful Patient Partnership/Engagement model (BMC Pul Med 2014)
• A Cost effectiveness analysis of the multi-center Canadian study on over-diagnosis of asthma revealing that algorithmic approach to proper diagnosis of asthma, even after many years, is still cost effective (BMC Pul Med 2011)
• A study describing asthma-obesity interaction showing that people who are obese and have asthma, have lower lung function and more co-morbidities compared with normal-weight people with asthma (Chest 2010) 
• The first study to describe weigh loss leading to improvement in asthma severity demonstrated by improvement in methacholine challenge test in people with asthma and obesity (Chest 2015) 
• The first pilot randomized study in tertiary care out-patient respirology clinic using the Ottawa Model of Smoking Cessation with subsidized nicotine replacement therapy leading to improved quit rates in patients with moderate to severe lung diseases such as COPD, lung cancer, pulmonary fibrosis etc. (CRJ 2015)   
• Designed, developed and published well validated quality of life scales:  McGill COPD Quality of Life Scale (COPD J 2011 and CRJ 2012), CF Knowledge Scale (Respirology 2014) and the CF Stigma Scale (BMC Pul Med 2014)  
• Related research exploring the importance of physical exercise in bronchial asthma (BMC Pul Med 2013), comprehensive review of severe asthma (CMCRPM 2011), comparison of per cent predicted and percentile methods in the interpretation of pulmonary function tests (CRJ 2009) and non-invasive diagnosis of stage-I sarcoidosis (SVDLD 2006).

Other Notable Activities

Dr. Pakhale established the first and only ‘Severe Asthma Clinic’ for the Ottawa-Gatineau region at the Ottawa Hospital. This led to the establishment of the first national Sickle Cell Disease Registry in 2022,  developed in partnership with the SCDAC. Dr. Pakhale also is a Global Burden of Disease (GBD) Collaborator and works with a trans-disciplinary scientists from around the world to assess mortality and disability from major diseases. In addition, Dr. Pakhale is a steering committee member of the Canadian Thoracic Society- Choosing Wisely Canada, and the Tobacco Action Committee of the American Thoracic Society.