Healthy Living, Healthy Life Conference Proceedings
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Supporting oral health and caregiving: research, policy and everyday practice
This initiative follows research findings and outputs of Nova Scotia‘s Brushing Up on Mouth Care Project. In partnership with Caregivers Nova Scotia and supporting needs arising from recently implemented Nova Scotia Department of Health and Wellness policy Long Term Care Program Requirements: Nursing Home & Residential Care Facilities that, for the first time, includes explicit standards for daily mouth care practice in the continuing care sector.
Copyright (c) 2019 Healthy Living, Healthy Life Conference Proceedings
Rehabilitation optimization following a stroke by telerehabilitation combined with video-games
Telerehabilitation combined with video games provides a new approach that may facilitate rehabilitation services access, in patients with stroke. We used a multiple case study, in order to identify barriers and facilitators to using this technology by stakeholders and to developp knowledge translation activities based on the findings.
Strengthening Families Program: Canadian data from our first two years
The Strengthening Families Program is a commercially available family intervention program available out of the United States. To our knowledge there has been no peer-reviewed studies evaluating the value of this program for use in a Canadian context. The present study provides data from the first two years of a Canadian intervention study using the SFP within a northern, urban-rural British Columbia community.
Strengthening Families Program: Qualitative data from our first two years
The Strengthening Families Program (SFP) is a family intervention program developed by Karol Kumpfer that is currently available from the United States. Our community started providing SFP intervention in Fall 2014 and, since beginning the program, have collected qualitative information regarding perceptions about the program. This presentation will review our qualitative findings from our first wo years.
It's no dream. Sleepwell without sleeping pills.
Sleepwell helps people find an effective and safe treatment for insomnia without the need for sleeping pills. It provides a gateway to cognitive-behaviour therapy for insomnia (CBTi), an effective form of sleep therapy. New insomnia treatment guidelines state CBTi is first-line treatment. Sleepwell is helping make this recommendation a reality.
The Efficacy of a Self-Management Mobile App for Spinal Cord: Protocol of Randomized Controlled Trial
Spinal cord injury (SCI) requires complex self-management skills to avoid secondary health complications and to maintain overall health. The aim of this study is to determine the efficacy of a self-management mobile app for people with SCI. Changes in goal attainment scaling will be evaluated among immediate and delayed intervention groups in a randomized controlled trial.
The Role of Trees and Greenspace in Healthy Urban Living
In this workshop, participants will learn about how trees and access to green and blue spaces support health and health promoting behaviours, and how the urban forest supports urban sustainability and resilience to environmental challenges.
Hijacked and Leveraged: Big Alcohol Marketing in One Canadian Community
During Halifax‘s 2012 Tall Ships festival, a family-friendly cultural event, the alcohol industry used sponsorship tactics to promote sales and increase brand loyalty. Sponsorship policy is an effective way to decrease population alcohol harms. Policy makers need to see alcohol sponsorship and advertising as the same, to reduce the space that the alcohol industry has to operate.
Integrating Steps to Connect to Support Self-Management Across Sectors
Steps to Connect is a leisure education program designed to support people living with chronic conditions to engage in community recreation as part of self-managing their condition. The purpose of this workshop is to explore how leisure education can be used to support chronic condition self-management in community recreation settings.
Applying complex systems to school food environments in Nova Scotia
Comprehensive initiatives, including policy, are necessary to produce population-level changes in health, including childhood nutrition, with schools being recognized as an essential intervention setting. Applying a complex systems lens provides an opportunity to consider interactions and roles within the system and identify potential intervention targets to support SFNP implementation
Food in Focus: Youth Exploring Food in Schools
Youth perspectives are often lacking in research on school food. This study used photovoice, a methodology based in participatory and critical approaches, to engage youth to critically reflect on their school food environments and their role in making positive changes.
Exposure to Nature Improves Attention in Typically Developing Children
Children currently spend minimal time in nature. Disconnection from nature may impact health in a variety of ways, including reduced attentional abilities. We examined children‘s attention before and after a 30-minute exposure to an urban or natural environment. The nature condition, but not the urban condition, led to improved attention.
How might community partners sustain the Halifax Mobile Food Market?
Mobile food markets (MFM) are interventions which can support healthy eating within lower-income communities. Community partnerships are important in sustaining the Halifax MFM, but little is known about how partnerships function in this context. The proposed project will explore how partnerships operate to influence outcomes of the MFM in Halifax.
Partnering Together: Improving Access to Chronic Disease Exercise Programs in the Community
The collaboration between Community Health Teams (Nova Scotia Health Authority) and a community recreation facility, Canada Games Centre, to offer a free 10-week exercise program to individuals living with chronic conditions demonstrates that building strong relationships and collaborating on shared priorities has the strong potential of improving health outcomes for community members.
The role of the health professional in smoke-free housing policy
Smoke-free housing policy is an emerging area of tobacco control that addresses health inequities. Health professionals within the Nova Scotia Health Authority can reduce multiple unhealthy exposures through facilitating smoke-free policy formulation and adoption at the institutional level.
Healthy Farm to School Fundraising with Nourish Your Roots
Nourish Your Roots (NYR) is a healthy farm-to-school fundraising program of Nourish NS designed to: support the Food and Nutrition Policy for Nova Scotia Schools; help sustain healthy food-related programming in schools; and support the whole, healthy local food economy in Nova Scotia.
Since 1971, the North End Community Health Centre (NECHC) has been providing collaborative, multi-disciplinary health services to the North End Halifax community. Learn more about the NECHC Good Food Box program and how it inspired a larger project to influence policy change; the North End Food Coalition – a first voice project.
Impacts of a Community Collaboration on Non-profit Organizations, Students and People with a Chronic Disease
A facilitated panel discussion that includes members of two non-profit community organizations, people with sleep-related breathing disorders, and respiratory therapy students, will discuss their shared and unique experiences in a community-based collaboration that provides refurbished medical devices to those with low income or without private health insurance.
Tackling the Taboo: Addressing Sexual Health in Acute Care
The application of a feminist post-structural lens to sexual health in the acute care setting may be used to understand, question and challenge how social and institutional beliefs, values, and practices surrounding sexual health are experienced by health professionals and patients, leading to transformations in health care practice and policy.
OHC: A community invests in Health and Wellness
OHC is a collaborative health centre in rural Nova Scotia. Acknowledging a need for improved health and wellness, the community took it upon itself to raise the funds, identify pertinent services, programs, and professionals to fulfill our vision. Our doors opened in 2016; we feel our story is unique.
Healthy Dying: Gay and Bisexual Men‘s Expectations for End-of-Life
Older LGBTQI2S adults are often invisible in end-of-life care planning and preparation. With data from a national study, this research focused on unique needs of older gay and bisexual men. In exploring their needs, this study gained understanding of their perceptions of death and the processes of dying.
Bisexual Women‘s Strategies to Reduce Cannabis Use Risks
Bisexual women are more likely to use cannabis than heterosexual or lesbian women. Our community based study collected qualitative data from 16 bisexual women who use illegal cannabis twice weekly. Findings identify risks women associate with using cannabis, how women negotiate these risks, and the possible impacts of cannabis legalization.
Addressing Colonial Trauma Through Mi'kmaw Film Representation
Mi‘kmaw directors represent land, language, violence, and gender/sexuality in ways that address intergenerational colonial trauma and support cultural survival. We conducted interviews with three Mi‘kmaw directors (Jeff Barnaby, Bretten Hannam, and Cathy Martin), and critically analyzed their films, Rhymes For Young Ghouls, North Mountain, and The Spirit of Annie Mae.
African Nova Scotian Nurses Experiences as Leaders in Health Care
This presentation will consist of a proposal and literature review for doctoral research. The discussion will focus on the application of Black Feminism to understand the experiences of African Nova Scotian nurses as leaders in health care. Social and institutional discourses will be explored.
Recreation for Mental Health: Older Adults Overcoming Barriers
Leisure and recreational activities have many health benefits, but people with a mental illness, and especially older adults, often face personal, social and environmental barriers to accessing such activity. Drawing on qualitative methods, this study examines the barriers faced by older adults, and makes recommendations to overcome them.
Building a Health Equity Agenda for People of African Descent
This presentation examines the current state of health research on people of African descent, and provides suggestions for building a Health Equity Agenda for People of African Descent that reflects and addresses the health and mental health needs of this population through research, policy, university curricula, and services.
An Innovative Non-Profit Organization Serving Criminalized Women in the Perinatal Period
This paper describes the work of Women‘s Wellness Within (WWW), a registered mon-profit organization serving criminalized women in Nova Scotia (NS) in the perinatal period.
The Cards You Are Dealt: Stories of Labeled Men
Participatory Action Research is a viable method to facilitate Occupational Therapy (OT) groups, promote self-growth in group members and address research gaps pertaining to the role of OT in the community. A Photovoice project with men transitioning into the community post-incarceration will be the focus of this presentation.
The Pan-Canadian Health Inequalities Reporting Initiative
The Pan-Canadian Health Inequalities Reporting Initiative aims to advance health equity in Canada by making available evidence to support health inequalities research, program and policy interventions through two main products: the Health Inequalities Data Tool and an accompanying narrative report on the most pronounced inequalities in Canada.
Employment of Occupational Concepts within Return to Work (RTW) Literature
Occupational concepts are utilized by return-to-work (RTW) processes to describe the social determinants of recovery. We were interested in which occupational concepts and occupational fields were mentioned in the RTW/BTW academic literature. Occupational health and safety-related terms were utilized more than those used within occupational therapy and occupational science.
Young Adult Health Profiles at Admission: Insights for Residential Services
Younger adults (YA) living in residential long-term-care designed for older adults (RLTC) face distinct barriers to health and well-being. Admissions assessments of YA admitted to RLTC, were mapped to the ICF and social determinants of health. Patterns in personal and contextual factors inform alternative RLTC models for this vulnerable population.
Drawing on Eastern Europe to Change Canadian Health Profession Education
The enlargement of Europe and social changes, like the ageing population, cultural diversity, economic changes, poverty and social and health inequality, have required changes in health/social profession education. This presentation will spark dialogue on change by considering the unique development of Eastern Europe occupational therapy education directed at social/health reform.
Postpartum Depression: the Great Shame of Motherhood
Postpartum depression is a significant illness that affects mothers‘ ability to care for themselves and their infant. Left untreated, it has been associated with insecure attachment in infants and emotional difficulties in children, yet many mothers do not seek help. This study begins to examine some of the reasons why.
Enhancing Undergraduate Medical Education with Community Engaged Learning Experiences: Results of a Two Year Evaluation of a Service Learning Program
The Service Learning Program requires participation in in preparations, critical reflection and community-engaged learning experiences. These experiences include the completion of projects based on community-identified priorities. A program evaluation was completed with recommended changes and celebrated successes outlined. Results were positive overall and offers pathways for creating social accountable institutions.
Health Equity for LGBTQ+ Patients through Competency-Based Medical Education
Inclusive health spaces are essential to providing equitable health care. Minority populations, like the LGBTQ+ community, are susceptible to current shortfalls in equitable care provision. To provide equitable care to the LGBTQ+ population, physicians must be trained to provide culturally competent care as part of their undergraduate medical education.
The power of youth engagement in policy, programs and knowledge translation
Engagement in the decisions that affect them is positive for both youth and services across many sectors. Youth engagement is at the heart of all that we do at Wisdom2Action. It‘s a commitment, an approach and a promising practice that we promote across the youth serving sector. Young people gather on our Youth Advisory Committee, they sit on our Governing Board, identify and develop projects, lead mentoring projects with other organizations on youth engagement and lead our community engagement events. Since 2013, we have been providing guidance and training to organizations and governments across Canada and internationally on youth engagement. We have also modelled youth engagement as a promising practice through our public events. In 2013, we completed a knowledge synthesis report on youth engagement (Zinck, Ungar, Whitman, Exenberger, LeVert-Chaisson, Liebenberg, Ung, & Forshner, 2013). In 2018, this report was updated in advance of the first national Canadian conference on youth engagement led by Wisdom2Action. This presentation will engage participants in shared learning about how to implement youth engagement in diverse organizations and contexts.
Building Partnerships Toward Equitable Refugee Healthcare
Immigrant Services Association of Nova Scotia (ISANS) Refugee Health Program aims to address systemic and socially produced health disparities among newcomers. Working with various institutions, partnerships are created support equitable access to health care, addresses social determinants of health, and facilitate diversity and inclusion.
Drug-Free Prescription Programs In Halifax: Environmental Scan and Preliminary Recommendations
Food insecurity continues to be a prevalent and highly impactful concern for many Canadians, where families in Nova Scotia are affected above the national average. This environmental scan examines existing drug-free healthy food prescription programs targeting food insecurity, and suggests key recommendations for future program implementation.
The embedded researcher experience and population health system impact in Nova Scotia
Our purpose is to present an overview of the embedded fellow experience of the inaugural CIHR Dalhousie University-Nova Scotia Health Authority Health System Impact fellowship. The population health project for this fellowship is described, alongside its implications for broader health system impact and future directions using this embedded researcher model.
Doctors and Us: A Community-Based Project by the Inclusive Research Network
People with intellectual disabilities face many barriers to healthcare access including: physical, societal, and language issues. The Inclusive Research Network, a team that include self-advocates, service providers, academic researchers, completed a series of focus groups to find ways to help people feel more at ease when talking to doctors.
Fountain of Health Initiative for Optimal Aging
An oral presentation will be given on how The Fountain of Health (FoH) Initiative for Optimal Aging has become a leading movement in positive psychiatry in Canada. The presentation will review how FoH has approached the theoretical issues in health practices and the importance of preventative efforts.
Unlocking the Potential of Interprofessional Students to Advance Health Care: Learning from two student led environments
A three-way partnership between Holland Bloorview Kids Rehabilitation Hospital, University Health Network and the Centre for Interprofessional Education in Toronto has supported the development of interprofessional student led environments in two very different healthcare care settings. These initiatives confirm the value of these placements for students, patients, preceptors and administrators.
Physical Activity as a Predictor of Sleep Quality and Quantity Among Preschool-Aged Children
Poor sleep is common among children. It is important to determine ways to promote healthy sleep in children. The study will examine the relationship between physical activity (PA) and sleep among children. Children will wear accelerometers to measure PA and sleep. A survey will also be used to measure sleep.
ATP Metabolism in RBC as Biomarker for Post Exercise Hypotension
The importance of ATP in energy metabolism has long been recognized. Exercise has been shown to increase ATP metabolism in the RBC which may be an important mechanism for post exercise hypotension. We summarize current evidence in support of ATP metabolism in the RBC as a biomarker for cardiovascular protection.
Thematic Analysis of Children‘s Health Care Play
This study documents ways that preschooler‘s display health literacy. A participant-observation qualitative study in a preschool classroom (n=28) involved the introduction of health care materials for child-directed play. Six themes illustrate children‘s understanding, knowledge and behavior about health and health care as observed during the health care play.
HPI Core Competencies Framework for Population Health Educators, Leaders, Trainees
Dalhousie University‘s Healthy Population Institute embarked on a research project to understand the core competencies needed for emerging leaders in population health. Through an environmental scan, consultations, and iterative feedback process, the HPI Core Competencies Framework was created to guide learning opportunities for graduate students in population health.
Using the Theoretical Domains Framework to Identify Barriers and Facilitators to Exercise Among Older Adults Living with HIV
Qualitative study using the Theoretical Domains Framework to investigate the barriers and facilitators to participation in exercise of 12 older people with HIV, using in-depth semi-structured interviews. People aging with HIV experience many barriers to exercise, including environmental and resource constraints, co-morbidities, injuries, and the side effects of HIV disease and medication.
Parent-targeted postnatal educational interventions in developing countries: A scoping review
This scoping review found that increasingly parents are being provided with postnatal educational interventions in developing countries. Findings were varied in educational topics covered, method of education, and location of intervention. Most maternal outcomes and over half of neonatal outcomes had a significantly positive change after the postnatal intervention.
Atlantic Partnership for Tomorrow‘s Health: Opportunities for Collaborative Health Research
Atlantic PATH is a prospective cohort study with data on 35,000+ participants. A research platform has been established to provide researchers with access to questionnaire data, biological samples and physical measures. This data will facilitate research on the genetic, environmental and lifestyle factors related to cancer and chronic disease.
A three-way partnership between Holland Bloorview Kids Rehabilitation Hospital, University Health Network and the Centre for Interprofessional Education in Toronto has supported the development of interprofessional student led environments in two very different healthcare care settings. These initiatives confirm the value of these placements for students, patients, preceptors and administrators
Accelerometry-measured physical activity and sedentary behaviour of Nova Scotia preschoolers
National accelerometry-measured physical activity data on preschoolers exist, yet the physical activity of Nova Scotia preschoolers is largely unknown. This study describes the accelerometry-measured activity of Nova Scotia preschoolers and adherence with activity guidelines. Results revealed children spent the majority of their day active, and all children met the guidelines.
Using Inuit Qaujimajatuqangit in cervical cancer prevention and treatment among Inuit communities
This project will undertake a systematic, scoping review using Joanna Briggs Institute Methodology of current northern and traditional Indigenous literature within Canada and internationally, with a specific focus on cervical cancer, wellness, IQ, traditional knowledge and culturally safe/competent practices.
Exploring Interprofessional Placement in Healthcare Education
This systematic review aims to synthesise student, educator and service-user experiences of interprofessional placements. Research to date has mainly focused on student experiences, with less focus on educator and service-user experiences. Findings have mainly come from questionnaire and focus group data. An ethnographic case study could explore multiple stakeholder perspectives.
Collaborating to Promote Healthy Living: Community Recreation and Chronic Conditions
Although the Expanded Chronic Care Model provides a framework for understanding how to support people with chronic conditions to live well in their communities, greater integration of community recreation as a support for chronic condition management is needed. Ways to conceptualize and prepare for community recreation collaborations are discussed.
Natural movement can predict all-cause mortality: Learn, Discuss & Play
Research shows that natural movement (sit and rise from the floor) can be used as a predictor of all-cause mortality. Facilitators will present information about factors that contribute to movement and facilitate discussion and hands-on experience. Leave with the knowledge and tools to decrease your risk of mortality.
Pharmacists' experiences in Headstrong - Taking Things Head-On, a men's mental health program delivered through community pharmacies
Raising Awareness of Canada's Low-Risk Alcohol Drinking Guidelines
A population based, public education campaign was launched in Prince Edward Island between June 2016 and April 2017 to increase awareness of Canada‘s LRDG. The campaign was effective at increasing awareness of the LRDG, though uptake was lowest among those at highest-risk for heavy drinking.
Essential oils: Revolutionizing home and clinical practices
Research demonstrates that essential oils carry antimicrobial properties and immune enhancing effects. The objectives are to explore research and discuss realistic applications of essential oils in sanitization, sterilization, food preparation and patient-care practices. As time permits, discussion on pragmatic aspects of transforming individual habits and clinical practices is welcome.
Green areas and connection with nature as a tool for well-being
This paper presents preliminary findings of an investigation conducted in the Great Metropolitan Area of Costa Rica which aims to establish the impact of connection to nature on the inhabitants wellbeing
Supporting chronic condition self-management: A clinician perspective
This qualitative study examined clinicians on Chronic Disease Teams in Nova Scotia‘s perspectives of self-management. Findings indicate that they often view self-management as an individual journey. They believe that effectively working with self-management involves considering what is important to patients, their coping strategies, and difficulties they may be encountering.
Implementing person centred care in the post anesthetic care unit
From Random Acts of Wellness to Institutional Workplace Wellness Strategy: Dalhousie‘s Case
Representatives from one organization‘s Healthy Workplace Committee will share their “total health” approach to workplace wellness. They will review their journey from “activity” to “impact” as they capitalize on synergies from across the organization and build institutional capacity so wellness is no longer just an HR function.
Addressing Workplace Stigma for Injured Workers Managing Chronic Pain
The workshop titled, “Addressing Workplace Stigma for Injured Workers Managing Chronic Pain,” seeks to expand the knowledge base and inspire members of the helping professions, injured workers, and employers to promote collaborative work in chronic pain management within RTW/SAW planning, thereby creating healthy, productive, and tolerant, working environments.
Intimate Relationships and Women's Health
Past research has established that a high percentage of women in violent relationships experience a traumatic brain injury, with one article estimating approximately 23 million women in the US living with a TBI from intimate partner violence. The present research investigates this relationship from a qualitative perspective.
Early Childhood Education: Need for Collaborative Outdoor Play Learning Strategies
Documented gaps in outdoor play and learning training in early childhood education highlight potential opportunities for the development of collaborative strategies among early years and health sectors. This study describes the early childhood education outdoor play and learning data from 16 Nova Scotia Child Care settings.
Working collaboratively to support frail older people stay in the community as they age
A group of multidisciplinary and intersectoral collaborators with a shared interest in supporting older people live well in the community, facilitated knowledge creation and design of a tool to support planning for staying at home through health and functional changes.
How physically active are Nova Scotia preschoolers during childcare hours?
Physical activity during the early years is critical for healthy childhood development. The majority of Nova Scotia preschoolers attend licenced childcares, yet there is limited information on how physically active they are while there. This study will describe the accelerometry-measured physical activity of preschoolers from 16 Nova Scotia childcare settings.
A Comprehensive workplace health intervention assessment: A mixed methods study
A comprehensive workplace wellness program (WWP), targeting multiple health behaviours in areas of physical, emotional, mental and spiritual wellbeing, improved thriving, resilience, physical health, presenteeism, life purpose behaviour, physical activity and nutrition outcomes for financial consultants over a 16-week study period, in an organization mostly absent WWP best practices.
Above and Beyond: The Work of Staff in Long-term Care
Focus groups and interviews were conducted with staff to identify their experiences in long-term care. Themes resonating with the literature included teams, scope of practice, staff shortages and residents‘ home as well as a newly emerging theme of staff going “above and beyond” their clinical duties to care for residents.
Accounting for Indigenous context in population-based oral health intervention studies
First Nations in Unama‘ki (Cape Breton) seek improved oral health outcomes. A realist review of literature was used to identify potential interventions. The review found that current literature describes interventions which report community involvement in consultation and program delivery, but do not necessarily integrate foundational Indigenous philosophies into intervention approaches.
The Development of a KNee Osteoarthritis Walking Score (KNOWS).
Patient-reported outcomes drive clinical OA management, however these outcomes may not reflect how knee function is altered by OA. Therefore, the development of a multivariate KNee OA Walking Score (KNOWS) may deliver an objective measure of knee function that can be integrated into clinical decision making.
Discussion Groups for Patient and Public Engagement
Patient and public engagement (PPE) is essential for collaborative health research in Canada. PPE must be carefully planned to ensure the expertise of patients, the public, and communities is applied to inform project decision-making. This 90-minute workshop will instruct participants in planning and conducting discussion group activities for PPE.
Because Bladder Matters-Reducing Post-Surgical Urinary Tract Infection
Urinary tract infection is the fourth leading cause of healthcare associated infections. Indwelling catheters are stressful, restrictive, and is a substantial care burden. Our goal is to reduce the rate of urinary tract infections by 50% through collaboration involving the interprofessional team utilizing the “4 E‘s approach.
Health Policy Capacity Framework Adaptation using the Delphi method
Ensuring the success of health policies requires substantial policy capacity. An existing conceptual framework for policy capacity was adapted based on input from health policy experts using the Delphi method. The resulting framework is a tool to facilitate the assessment of health policy capacity.
Physical Literacy in the Early Years: A Loose Parts Intervention
The Physical Literacy in the Early Years project is examining whether preschoolers who participate in active outdoor play, facilitated by educators trained in embedding loose parts into outdoor spaces, enhances their physical literacy. The study‘s protocol will be shared, along with the potential impact on policy/practice changes in early years.
Translating Collaboration into Practice: Using Simulation to Enhance Team Functioning
Collaborative practice within health care teams has been shown to be positive for the patient, provider and system. Interprofessional collaborative practice can be challenging, with barriers at every turn. Simulation can help identify and help participants enact and see the change that is possible.
Let‘s put our lessons to use: Refining a framework for building on successful patient and public engagement in health research
This workshop will involve participants in refining a draft framework for scaling-up successful elements of partnerships between researchers, patients, the public, and other stakeholders in health research. In this context, ‘scaling-up‘ involves identifying ‘what works‘ to make partnerships successful and ways to build on these successes in other projects.
Measuring Adverse Childhood Experiences and Resilience in Primary Health Care
This presentation will summarize results from a research project piloted among three hundred adult patients of the Lunenburg Family Health Clinic who completed a survey that measured adverse childhood experiences, current health challenges and factors promoting resilience. Future implications for multi-disciplinary and collaborative care settings will be discussed.
Building a Patient Medical Home Using a Data-Driven, Physician-Led Approach
At the Calgary West Central Primary Care Network (CWC PCN), we use a data-driven and physician led approach to assist primary care practices in building Patient Medical Homes (PMHs). Presenters will discuss the uniquely collaborative approach that the PCN has taken to facilitate this process.