Creating Safe Connections: A Co-Designed E-Learning Module to Advance Equity and Social Accountability in Preventative Primary Care

Ambreen Sayani,1,2 Zeenat Ladak,1,3 Jackie Manthorne,4 Erika Nicholson,5 Gary C Bloch,6,7 Janet Parsons,2 Stephen W Hwang,6 Bikila Amenu,8 Howard Freedman,8 Tara Jeji,8 Angus Pratt,8 Vinesha Ramasamy,8 Jean-Claude Camus,8 C Nadine Wathen,9 Jennifer CD MacGregor,9 Danielle Dilkes,10,11 Aisha Lofters1,12,13 1Women’s College Hospital Research & Innovation Institute, Women’s College Hospital, Toronto, Ontario, Canada; 2Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; 3Applied Psychology & Human Development, University of Toronto, Toronto, Ontario, Canada; 4Board of Directors, Canadian Cancer Survivor Network, Ottawa, Ontario, Canada; 5Executive Team, Canadian Partnership Against Cancer, Toronto, Ontario, Canada; 6Family and Community Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada; 7Board of Directors, Inner City Health Associates & Health Providers Against Poverty, Toronto, Ontario, Canada; 8Patient Partner, Women’s College Hospital, Toronto, Ontario, Canada; 9Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada; 10Centre for Teaching & Learning, University of Western Ontario, London, Ontario, Canada; 11Curriculum, Teaching, & Learning, University of Toronto, Toronto, Ontario, Canada; 12Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada; 13Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, Ontario, CanadaCorrespondence: Ambreen Sayani, Women’s College Hospital Research & Innovation Institute, Women’s College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada, Tel +1 416 323 6400 ext 3772, Email [email protected]: Lung cancer is the leading cause of cancer-related deaths worldwide and in Canada. Primary care providers (PCPs) play a vital role in incorporating lung cancer prevention and early detection into routine practice. This study outlines the co-design of Creating Safe Connections, an e-learning module developed to build PCPs’ capacity to deliver equity-oriented preventative care.Methods: This manuscript describes the pre-design and co-design phases of the innovation process, guided by the Generative Co-Design Framework for Healthcare Innovation. The pre-design phase established a governance structure comprising patient partners with lived/living experience and interest-holders including PCPs. During the co-design phase, key module priorities and research goals were identified, including barriers to access, stigma and trauma, and operationalizing equity-oriented care. All aspects of the module—its name, logo, content, and knowledge mobilization strategies—were co-developed with the patient partners and health system partners. To inform the e-learning module content, interviews were conducted with community-based PCPs in Ontario, Canada to explore how they apply equity-oriented skills in practice. Interviews were analyzed using deductive content analysis.Results: PCPs’ (five family physicians, two nurse practitioners) interview analysis was informed by the four pillars of Trauma- and Violence-Informed Care: recognizing the impact of trauma and violence; creating emotionally, culturally, and physically safe environments; promoting choice, collaboration, and connection; and adopting a strengths-based, capacity-building approach. These themes shaped the co-design of a Continuing Medical Education-accredited module, which includes video narratives, case studies, a learner’s notebook, and interactive assessments.Conclusion: This work offers a model for the participatory co-design of equity-focused educational interventions that bridge gaps in provider training while aligning with the care needs and priorities identified by structurally underserved populations. The module uses lung cancer screening as a case example to illustrate approaches to addressing inequities in preventative care.Keywords: patient-partnered, accessibility, asynchronous learning, patient-centered care, lung cancer screening, smoking cessation, trauma- and violence-informed care, co-design, lived experience expertise