Dr. Stacey Lovo
Photograph provided by Dr. Stacey Lovo
by Sarah Kasleder for SHRF
Indigenous children in remote and rural communities in Saskatchewan face difficulties in accessing rehabilitation services due to the lack of pediatric rehabilitation providers, as well as the travel time and costs required to attend urban centers. Dr. Stacey Lovo’s research focuses on improving this access using virtual health technologies, particularly remote presence robotics, and collaborating with the Indigenous community in the research process. This innovative approach, recognized with a SHRF Excellence Award for the top-ranked 2023-24 Establishment Socio-Health Grant, prioritizes Indigenous community voices and aims to address the healthcare inequities faced by Indigenous children in Saskatchewan.
We recently did an interview with Dr. Stacey Lovo to gain insights into her community-driven research approach.
“So, just to start, what inspired you to embark on this research journey, particularly addressing the health inequities faced by Indigenous children in Saskatchewan?" Asked Sarah, the SHRF interviewer.
"In 2012, a number of things happened in my physical therapy clinical practice that helped me to realize the reality of inequitable healthcare for remote Indigenous Peoples in Saskatchewan," Dr. Lovo begins, setting the stage for her transformative journey.
Putting Relationships at the Center of Research and Pivoting to Pediatrics
Her journey began with orthopedic virtual health, focusing on providing rehabilitation care for musculoskeletal conditions in partnership with the Peter Ballantyne Cree Nation and guided by a circle of eight Elders in Pelican Narrows. These virtual care systems utilize remote presence robots, allowing healthcare providers to interact with patients remotely. Peter Ballantyne Cree Nation has led the way in Saskatchewan using remote presence.
"34% of our population in the province lives in a rural and remote region, whereas only 5% of physical therapists provide care in those regions," Dr. Lovo emphasizes, shedding light on the staggering gap in healthcare accessibility.
She has worked closely with the Pelican Narrows community and Peter Ballantyne Cree Nation Health Services since 2015 on remote presence robotics, making significant strides even before the onset of the COVID-19 pandemic.
“The success of the research lies in its community-driven nature.” Dr. Lovo reflects, highlighting the longevity of the collaborative efforts and the profound impact of nurturing relationships with the community over an eight-year span. Dr. Lovo expands on community collaboration and what that meant for the trajectory of the research; "The beauty of this research lies in the relationships built over the years. It's about trust, understanding, and shared goals.”
"The Elders guided us that the next most urgent priority for them and their community was pediatric rehabilitation care, which is why we submitted an application for the SHRF Establishment Grant," Dr. Lovo shares.
This shift marked the beginning of pediatric rehabilitation remote robotic research, which will involve physical therapy, occupational therapy, and speech-language pathology, addressing the needs of children in communities such as Deschambault Lake, Pelican Narrows, and Southend.
Bridging the gap in healthcare utilizing robotics and virtual healthcare systems
Since not many of us are used to robots when we think about pediatric rehabilitation, Dr. Lovo is able to paint a picture to showcase how the robot, nurse and patient interact.
From the interview, we understood that these virtual care systems, operated by healthcare providers through laptops or mobile devices, bring the healthcare provider virtually into the patient's room through a robot. The technology facilitates consultations and interactive features like video sharing, movement demonstrations, and virtual examinations.
This is a collaborative and team-based model, with a nurse actively participating with the patient. This unique strategy places the patient and family at the center of care, emphasizing a holistic and comprehensive approach to healthcare delivery. The robot enables effective communication between the healthcare provider, the nurse, and the patient. As a result, the virtual team examines the patient's history, takes a physical examination, and engages in ongoing dialogue, creating a seamless, personalized treatment experience for the patient.
The remote presence of robots transcends geographical barriers, offering a lifelike and personalized connection that goes beyond the constraints of traditional telehealth methods. “The remote presence robot becomes the bridge that connects healthcare providers with patients and communities that are otherwise underserved," Dr. Lovo expressed.
As the research progresses, the Elders of Pelican Narrows and the Peter Ballantyne Cree Nation Health Services Board continue to guide the project with regular meetings, sharing circles, interviews, and discussions. The relationships forged during these interactions become the backbone of the research.
Community-Driven Data Collection: Guiding Indigenous Research Outcomes
During the interview, Dr. Stacey Lovo emphasized the critical role of Indigenous communities in directing the research, ensuring that the types of outcomes, measures, and evaluations conducted are responsive, relevant, and aligned with Indigenous knowledges. Collaborating closely with community members, including Knowledge Keeper Sally Sewap and Elder Rose Dorian, the research team identified specific indicators and outcomes crucial for understanding the impact of virtual technology and the remote presence of robots on pediatric healthcare experiences. Communities actively participate in selecting outcome measures and modifying them to ensure cultural responsivity. They focused on collecting experiences and stories to better understand how they felt about virtual technology and the challenges associated with travelling for healthcare.
A comprehensive needs assessment was conducted in partnership with the community of Pelican Narrows prior to the SHRF Establishment Grant and was completed by Ph.D. Candidate Haley Dunn. Community-directed needs assessment is at the core of Dr. Lovo's approach.
Questions asked during the needs assessment ensure that the research remains patient and family-oriented, aligned with the unique needs and strengths of the community. Dr. Lovo’s commitment to community-driven research is exemplified by these questions exploring diagnoses, functional challenges, and travel burdens, which helps lead the research team and community to understand how to improve the quality of life for children and families:
“Some of the questions include children's diagnoses, functional difficulties, including movement, daily living difficulties, speech and language concerns, and what types of supports children and families need. We also ask about their ability to participate in cultural, school, and family activities, all of which make our lives rich and meaningful. We ask what it is like to travel outside of the community. What's it like to travel five hours for a half-hour physical therapy visit? How does that impact your family or the roles you play in your family? And finally, what services and supports would they like to see? We also learn about the family and community strengths that are so critical to child and family wellness and will guide the intervention.”
Dr. Lovo explains further about the care involved and the success of the research, "By delivering care within the community and adopting a family coaching style for pediatric rehabilitation, we aim to facilitate the application of rehabilitation strategies for children at home, minimizing the need for constant travel. If we find out that we can provide high-quality services that enhance the quality of life for children and their families, we will succeed. If we can learn from this research and expand in partnership with other communities, that's another sign of success.”
This community-driven approach to research ensures its cultural relevance and reflects a commitment to respecting and prioritizing Indigenous perspectives in the evaluation process. This genuine commitment to partnership and empowerment within Indigenous communities contributed to the success and impact recognized by the Excellence Award. The outcome measures continue to evolve as the research progresses, guided by ongoing collaboration, ensuring the research remains responsive to the specific needs and priorities of Saskatchewan's Indigenous populations.
"We are hopeful that the community collaborative approach, a focus on a culturally responsive development and evaluation of models of care will provide examples of ways that rehabilitation systems can be directed by Indigenous knowledges."
Dr. Stacey Lovo's research spotlights collaborative, community-driven research and the transformative potential of technology. Beyond the immediate goal of improving access to pediatric rehabilitation services, her work sets a precedent for addressing systemic healthcare issues, ensuring culturally responsive models of care, and striving for healthcare equity in rural and remote Indigenous communities in Saskatchewan and beyond.
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