Manuscript Publications

Abstract

In the specificities of contraceptive care, sexual health is comprehensively defined as overall physical, emotional, mental, and social well-being related to sexuality, including experiences that are safe, pleasurable, and free of coercion. However, due to the predominance of biomedical paradigms that promote and espouse ‘unbiased’ and ‘objective’ contraceptive care practices, comprehensive, inclusive, and safe sexual health care remains limited. In this article, we argue that feminist poststructuralist knowledge is needed to reconceptualize sexual health care, ultimately promoting reproductive justice through social change and advancement of reproductive rights. We demonstrate how nursing as a discipline and profession can utilize feminist poststructuralist theoretical perspectives to challenge dominant discourses within contraceptive care and lead to the delivery of equity-owed contraceptive and sexual health care for cisgender women and people who can get pregnant.

Marshall, K., Wytenbroek, L., Bungay, V., & Oliffe, J. (2025). Reconceptualizing biomedical paradigms for contraceptive care through feminist poststructuralism. Witness: The Canadian Journal of Critical Nursing Discourse, 7(1), 6–22. https://doi.org/10.25071/2291-5796.172

Abstract

Gender-based violence (GBV) remains a pervasive public health crisis with devastating impacts on women’s health and well-being. Women experiencing GBV face considerable barriers accessing appropriate and timely health and social services. This study explored women’s experiences with health and social services in three Canadian cities to understand critical challenges and strengths in service provision for women experiencing GBV.

Rudzinksi, K., Hudspith, L., Guta, A., Comber, S., Dewar, L., Leiper, W., Hawkins, K., Laforet, L., Mangat, R.R., Long, P., Handlovsky, I., & Bungay, V. (2025). Navigating fragmented services: a gender-based violence (GBV) critical feminist analysis of women’s experiences engaging with health and social supports in three Canadian cities. BMC Public Health, 25, 1213: https://doi.org/10.1186/s12889-025-21919-w

Abstract

Changes to Earth’s biosphere causing intensification of climate crises worldwide are rapidly affecting human health. Advancing the acceleration of globalization and increased flows of migration, climate change contributes to rapid population change and increased population complexities in Canada, requiring nursing students to be better prepared to deliver care that is relationally ethical, action-oriented, and centred on mobilizing our social mandates of equity and justice. Women living at the crossroads of gender-based violence, racism, and migration status are one such complex population that is increasing exponentially due to geopolitical fragility and multiple global climate crises. Over 140 million women currently experience forced international migration, driven majorly by eroding ecosystems. Climate crises disproportionately affect women forced to migrate through exacerbating their exposure to violence, diminished social networks, limited access to adequate health care, and racial discrimination.

To foster nursing student readiness for practice and leadership aimed at an increasingly complex population demographic, we propose framing nursing pedagogy with intersectional environmentalism as an approach that builds on planetary health principles and the social and environmental justice mandates of the nursing discipline. We respond to at least two significant global and national challenges of the 21st century, including the health impacts of climate crises and the inequitable health experiences among women living at the axes of forced migration, gender-based violence, and systemic racism. Our discussion situates women living at these intersections within the context of climate change to promote the examination of the disparate impacts on women’s health and well-being. In situating intersectionality as described by Collins (1990, 2019), Crenshaw (1991), and the Combahee River Collective (1977, 1981), we draw attention to the need to tackle racism, sexism, and classism. We engage with intersectional environmentalism (Thomas, 2022) as a critical approach to inclusively engage with the complexity of how climate threats affect the health of women living simultaneously with gender-based violence, racism, and migration status.

Kassam, S. & Bungay, V. (2024). Advancing nursing education through an intersectionality-framed approach: An exemplar with women living at the epicenter of gender-based violence, climate crises, racism, and migration status. Quality Advancement in Nursing Education, 10(4), Article 5. https://doi.org/10.17483/2368-6669.1474

Abstract

Digital health provides a great opportunity to increase access to sexual health information and/or services. However, it can inadvertently cause emotional trauma to end users depending on how it is designed or deployed. In this study, we explored recommendations for designing trauma-informed digital health technologies and identified three preliminary themes. These include considerations for privacy and confidentiality, intuitive and representative designs and inclusive language.

Josephs, J. C., Bungay, V., Guta, A., Gilbert, M., & Abdulai, A.F. (2024). Trauma-informed technology designs in digital sexual health interventions. Innovation in Applied Nursing Informatics. 315: Ebook. https://ebooks.iospress.nl/doi/10.3233/SHTI240323

Abstract

Emergency Departments (ED) staff, including nurses and physicians, are most directly involved in the care of people who use unregulated substances, and are ideally positioned to provide harm reduction interventions. Conceptualizing the ED as a complex adaptive system, this paper examines how ED staff experience opioid-specific harm reduction provision and engage in harm reduction practice, including potential facilitators and barriers to engagement.

Jiao, S., Bungay, V., Jenkins, E., & Gagnon, M. (2024). Opioid-specific harm reduction in the Emergency Department: How Staff Provide Harm Reduction and contextual factors that impact their capacity to engage in harm reduction practice. Harm Reduction Journal, 21(1). https://doi.org/10.1186/s12954-024-01088-6

Abstract

People who are structurally disadvantaged and marginalized often report poor health care experiences, such as inequitable treatment, due to intersecting forms of stigma and discrimination. There are many measures of patient experiences of care, however, few are designed to measure equity-oriented health care. In alignment with ongoing calls to integrate actions in support of health equity, we report on the development and testing of patient-reported experience measures that explicitly use a health equity and intersectional lens. Our analysis focuses on two different scales: the Equity-Oriented Health Care Scale—Ongoing, which was evaluated in primary health care settings where patients have an ongoing relationship with providers over time, and the Equity-Oriented Health Care Scale—Episodic, which was tested in an emergency department where care is provided on an episodic basis. Item Response Theory was used to develop and refine the scales. The psychometric properties of each scale were also evaluated. The Equity-Oriented Health Care Scale—Ongoing was first tested with a cohort of 567 patients. The Equity-Oriented Health Care Scale—Episodic was subsequently tested in an emergency department setting with 284 patients. Results of the Item Response Theory analysis for each scale yielded a brief index that captured the level of equity-oriented care when care is ongoing (12 items) or episodic (9 items). Both scales showed evidence of internal consistency and concurrent validity, based on a high correlation with quality of care. They are brief, easy-to-administer patient-reported experience measures that can support organizations to monitor quality of care. Their availability enhances the possibility of measuring equity-oriented health care in diverse contexts and can provide nuanced understandings of quality of care through an intersectional and equity lens.

Browne, A.J., Varcoe, C., Ford-Gilboe, M., Wathen, C.N., Wilson, E., Bungay, V., & Perrin, N. (2024). Using a health equity lens to measure patient experiences of care in diverse health care settings. PLoS ONE 19(6): e0297721. https://doi.org/10.1371/journal.pone.0297721

Abstract

Social justice is widely advanced as a central nursing value, and yet conceptual understandings of social justice remain inconsistent and vague. Further, despite persistently articulated commitments to upholding social justice, the profession of nursing has been implicated in perpetuating inequities in health and health care. In this context, it is essential to establish both conceptual clarity and tangible guidance for nurses in enacting practices to advance social justice—particularly through regulatory, education and accreditation documents that shape the nursing profession. This Foucauldian discourse analysis examines how social justice is discursively positioned within nursing professional documents in Canada, and illustrates that social justice was largely discursively excluded from these texts. Where social justice discourses were invoked, we identified that four central discursive patterns obscured and de-centred this nursing value: (i) Vague language undermined professional commitments to social justice; (ii) Constructions of knowledge and awareness de-emphasized practice; (iii) Individualism discourses minimized institutional/professional responsibility; and (iv) Aspirational language obscured present action. Extending from this analysis, we contend that the nursing profession must re-examine how social justice is understood and articulated, and call for a re-conceptualization of social justice grounded in nursing practice toward remediating inequities in health and health care.

Slemon, A., Wonsiak, T., Delli Colli, A.-R., Blanchet Garneau, A., Varcoe, C., & Bungay, V. (2024) Social justice in Canadian nursing professional documents: A Foucauldian discourse analysis. Nursing Inquiry.  e12653 https://doi.org/10.1111/nin.12653

Abstract

Outreach is an important approach to improve health and social care for women experiencing street involvement (SI) or gender-based violence (GBV). Few studies have examined outreach approaches that incorporate SI and GBV. Drawing on feminist theories and principles of community-based research, we detail an inclusive co-design approach for an outreach intervention considering these interrelated contexts. Women with lived experience, researchers, and service leaders drew on research and experiential knowledge to define outreach engagement principles: tackling GBV, personhood and relational engagement, trauma-informed engagement, and harm reduction engagement. The resulting intervention integrates these principles to enable building and sustaining relationships to facilitate care.

Bungay, V., Dewar, L., Schoening, M., Guta, A., Leiper, W., & Jiao, S. (2024). Co-designing an outreach intervention for women experiencing street-involvement and gender-based violence: Community–academic partnerships in action. Violence Against Women, 30(8), 1760–1782. https://doi.org/10.1177/10778012241233004

Abstract

The intersection of dual public health emergencies—the COVID-19 pandemic and the drug toxicity crisis—has led to an urgent need for acute care based harm reduction for unregulated opioid use. Emergency Departments (EDs) as Complex Adaptive Systems (CASs) with multiple, interdependent, and interacting elements are suited to deliver such interventions. This paper examines how the ED is organized to provide harm reduction and identifies facilitators and barriers to implementation in light of interactions between system elements. Using a case study design, we conducted interviews with Emergency Physicians (n = 5), Emergency Nurses (n = 10), and clinical leaders (n = 5). Nine organizational policy documents were also collected. Interview data were analysed using a Reflexive Thematic Analysis approach. Policy documents were analysed using a predetermined coding structure pertaining to staffing roles and responsibilities and the interrelationships therein for the delivery of opioid-specific harm reduction in the ED. The theory of CAS informed data analysis.

Jiao, S., Bungay, V., Jenkins, E., & Gagnon, M. (2023). How an emergency department is organized to provide opioid-specific harm reduction and facilitators and barriers to harm reduction implementation: A systems perspective. Harm Reduction Journal, 20(1). https://doi.org/10.1186/s12954-023-00871-1

Abstract

Outreach is as a strategy employed by those in health and social services, which generally involves establishing relationships and providing support to people situated in hard-to-reach and hidden populations. However, there is a lack of clarity across the literature on how outreach is conceptualized, the central elements of outreach as a program and practice, and how the ‘success’ of outreach is empirically measured. Such gaps limit understandings of how outreach can be most effectively implemented and evaluated. The purpose of this scoping review responds to these challenges by systematically examining how outreach has been conceptualized, operationalized, and evaluated in community settings with hard-to-reach and hidden populations. This scoping review approach was undertaken in accordance with the 6-step framework developed by Arksey and O’Malley and advanced by Levac and colleagues. The search was conducted across four databases (CINAHL, MEDLINE, PubMed, and PsycINFO) and included research, review, and non-empirical articles published in English between January 1, 2008 and April 20, 2020.16,238 records were screened by title and abstract, followed by a review of 654 full-text articles and critical appraisal of 67 articles. Forty-two articles were included in the review, including 28 research articles (90%), two review, and two non-empirical. Findings illustrate that there is considerable variation in how outreach is conceptualized, implemented, and evaluated across the literature. Further, outreach is often inadequately defined, and predominantly overlooks the underlying and systemic reasons for clients’ “disengagement” from health and social care. Outreach providers and researchers are encouraged to draw on client-led aims, goals, and outcome measures to determine the enactment, evaluation, and measurement of outreach, and to explicitly position outreach as working alongside clients to remove structural barriers to care.

Jiao, S., Slemon, A., Guta, A., & Bungay, V. (2022). Exploring the conceptualization, operationalization, implementation, and measurement of outreach in community settings with hard-to-reach and hidden populations: A scoping review. Social Science & Medicine, 309. https://doi.org/10.1016/j.socscimed.2022.115232

Abstract

Public health is tasked with addressing the urgent global priority of promoting the health and human rights of adults engaged in sex work and research is critical to support this endeavor. ‘What’ is studied, ‘how’ research is done, and ‘who’ is centered in this research is reflected in how research funding is allocated. In this article, we interrogate funding allocation for sex work-related health research in Canada. Drawing on critical perspectives aimed at illustrating how stigma operates in society, we examine operating grants (N = 64) awarded by the federal health research funding agency between 2003 and 2020. We find that sex workers’ health is problematized disproportionately in a street marketplace context that centers on HIV and sexually transmitted infections. Limited work attends to the socio-structural context of sex work and instead perpetuates stigmatizing narratives about sex work. Public health intervention studies are rare, presenting a barrier for implementing and evaluating evidence-based health promotion strategies. Notably, the research projects were conducted by a small number of highly networked, geographically clustered researchers, illustrating gaps in research that considers the complexity of sex work. We propose that it is essential to consider funding as a process that may be limiting the range of health issues being addressed and privileging a small community of researchers, which can inadvertently serve to worsen health inequities among some sex work communities. Researchers and funding bodies may draw on this analysis to inform a research agenda that meaningfully supports the health, safety, and wellbeing of sex workers in Canada and globally.

Bungay, V., Guta, A., Varcoe, C., Slemon, A., Manning, E., Comber, S., & Perri, M. (2021). Gaps in health research related to sex work: an analysis of Canadian health research funding. Critical Public Health, 33(1), 72–82. https://doi.org/10.1080/09581596.2021.1987385

Abstract

The Everyday Discrimination Scale (EDS) is one of the most widely used measures of discrimination in health research, and has been useful for capturing the impact of discrimination on health. However, psychometric analysis of this measure has been predominantly among Black Americans, with limited examination of its effectiveness in capturing discrimination against other social groups. This paper explores the theoretical and historical foundations of the EDS, and draws on the analytic framework of Messick’s theory of unified validity to examine the effectiveness of the EDS in capturing diverse experiences of discrimination. Encompassing both social consequences and value implications, Messick’s unified validity contends that psychometric evaluation alone is insufficient to justify instrument use or ensure social resonance of findings. We argue that despite the robust psychometric properties and utility in addressing anti-Black race-related discrimination, the theoretical foundations and research use of the EDS have yet to respond to current discrimination theory, particularly intersectionality. This paper concludes with guidance for researchers in using the EDS in health research across diverse populations, including in data collection, analysis, and presentation of findings.

Slemon, A., Susan Dahinten, V., Stones, C., Bungay, V., & Varcoe, C. (2021). Analysis of the social consequences and value implications of the Everyday Discrimination Scale (EDS): implications for measurement of discrimination in health research. Health Sociology Review, 31(3), 247–261. https://doi.org/10.1080/14461242.2021.1969980

Abstract

Over the previous decade, there has been a notable shift within sex work marketplaces, with many aspects of the work now facilitated via the internet. Many providers and clients are also no longer engaging in in-person negotiations, opting instead for communications via technological means, such as through mobile phones, email, and the internet. By analysing the qualitative interviews of indoor-based providers, clients, and agency managers, this paper addresses the occupational health and safety concerns that indoor sex workers experience in the digital age, as well as how technology use can both support and hinder their capacity to promote their health and safety. Using thematic analysis, we arrived at three salient and nuanced themes that pertain to the intersection of sex work, technology use, and occupational health and safety: screening; confidentiality, privacy, and disclosure; and malice. As socio-political context can affect the occupational health and safety concerns that providers experience, as well as their capacity to prevent or mitigate these concerns, we highlight our findings in light of prevailing societal stigma and a lack of legal recognition and protections for sex work in Canada.

Jiao, S., Bungay, V., & Jenkins, E. (2021). Information and communication technologies in commercial sex work: A double-edged sword for Occupational Health and Safety. Social Sciences, 10(1). https://doi.org/10.3390/socsci10010023

Abstract

Men engaged in sex work experience significant stigma that can have devastating effects for their mental health. Little is known about how male sex workers experience stigma and its effects on mental health or their strategies to prevent its effects in the Canadian context. This study examined the interrelationships between stigma and mental health among 33 Canadian indoor, male sex workers with a specific goal of understanding how stigma affected men’s mental health and their protective strategies to mitigate against its effects. Men experienced significant enacted stigma that negatively affected their social supports and ability to develop and maintain noncommercial, romantic relationships. Men navigated stigma by avoidance and resisting internalization. Strategy effectiveness to promote mental health varied based on men’s perspectives of sex work as a career versus a forced source of income. Programming to promote men’s mental health must take into consideration men’s diverse strategies and serve to build social supports.

Jiao, S., & Bungay, V. (2018). Intersections of Stigma, Mental Health, and Sex Work: How Canadian Men Engaged in Sex Work Navigate and Resist Stigma to Protect Their Mental Health. The Journal of Sex Research, 56(4–5), 641–649. https://doi.org/10.1080/00224499.2018.1459446

Abstract

In this study, we examine the qualitative accounts of people who use drugs engaged in ‘peer’ work in harm reduction settings across British Columbia, Canada. We found peer work was precarious, characterized by nonstandard or casual work arrangements, high job instability and insecurity, insufficient wages, and limited social benefits. Participants were reluctant to exercise their rights or negotiate work conditions, such as higher wages or more consistent work, out of fear of job loss. However, the flexibility of peer work was beneficial for some in that it worked within their life circumstances and provided a low-barrier entry into the labor market. If inequities in peer work are perpetuated, unrecognized and unaddressed, precarious work conditions may continue to undermine the potential benefits of harm reduction work for organizations, peer workers and the people to whom they engage with and support. This study adds people who use drugs to the many social groups that are impacted by precarious work conditions globally.

Greer, A., Bungay, V., Pauly, B., & Buxton, J. (2020). ‘Peer’ work as precarious: A qualitative study of work conditions and experiences of people who use drugs engaged in harm reduction work. The International journal on drug policy, 85, 102922. https://doi.org/10.1016/j.drugpo.2020.102922

Abstract

This article presents findings from a grounded theory study in which we explored how self-identifying gay men between 40 and 76 years of age manage their health in the context of homophobia, heteronormativity and discrimination. Data were collected with 25 men over a 6-month period in a large urban setting in Western Canada. A preliminary theory of health management is discussed, consisting of the central phenomenon of overcoming adversity. Three thematic processes are considered that illustrate how adversity and health management are situated within the interrelationships of historical and ongoing discrimination inclusive of and external to the healthcare encounter, the complexity of men’s illnesses, and the temporal aspects of HIV epidemics and treatments that occurred throughout their lives. These themes include: advocating for health needs, knowing about health issues and treatments, and engaging in health promoting practices. These findings help to address a gap in knowledge concerning health management among older gay men and support that initiatives aimed at health care with gay men must appreciate the systemic role of discrimination, while supporting men’s individual efforts in actively managing their health.

Handlovsky, I., Bungay, V., Johnson, J., & Oliffe, J. (2020). Overcoming adversity: a grounded theory of health management among middle-aged and older gay men. Sociology of health & illness, 42(7), 1566–1580. https://doi.org/10.1111/1467-9566.13145

Abstract

Social inequities are widening globally, contributing to growing health and health care inequities. Health inequities are unjust differences in health and well-being between and within groups of people caused by socially structured, and thus avoidable, marginalizing conditions such as poverty and systemic racism. In Canada, such conditions disproportionately affect Indigenous persons, racialized newcomers, those with mental health and substance use issues, and those experiencing interpersonal violence. Despite calls to enhance equity in health care to contribute to improving population health, few studies examine how to achieve equity at the point of care, and the impacts of doing so. Many people facing marginalizing conditions experience inadequate and inequitable treatment in emergency departments (EDs), which makes people less likely to access care, paradoxically resulting in reliance on EDs through delays to care and repeat visits, interfering with effective care delivery and increasing human and financial costs. EDs are key settings with potential for mitigating the impacts of structural conditions and barriers to care linked to health inequities.

EQUIP is an organizational intervention to promote equity. Building on promising research in primary health care, we are adapting EQUIP to emergency departments, and testing its impact at three geographically and demographically diverse EDs in one Canadian province. A mixed methods multisite design will examine changes in key outcomes including: a) a longitudinal analysis of change over time based on structured assessments of patients and staff, b) an interrupted time series design of administrative data (i.e., staff sick leave, patients who leave without care being completed), c) a process evaluation to assess how the intervention was implemented and the contextual features of the environment and process that are influential for successful implementation, and d) a cost-benefit analysis.

This project will generate both process- and outcome-based evidence to improve the provision of equity-oriented health care in emergency departments, particularly targeting groups known to be at greatest risk for experiencing the negative impacts of health and health care inequities. The main deliverable is a health equity-enhancing framework, including implementable, measurable interventions, tested, refined and relevant to diverse EDs.

Varcoe, C., Bungay, V., Browne, A. J., Wilson, E., Wathen, C. N., Kolar, K., Perrin, N., Comber, S., Blanchet Garneau, A., Byres, D., Black, A., & Price, E. R. (2019). Equip emergency: Study protocol for an organizational intervention to promote equity in Health Care. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4494-2