You are encouraged to attend the defence. The details of the defence and attendance information is included below:  

Date:  Wednesday, November 26, 2025 

Time:  10:00 AM to 1:00 PM (PT)

Defence mode:  Remote 

Virtual Attendance: via Microsoft Teams 

Please contact the Office of Graduate Administration for information regarding remote attendance for online defences. 

To ensure the defence proceeds with no interruptions, please mute your audio and video on entry. The meeting will be locked to entry 5 minutes after it begins: please ensure you are on time.  

Thesis entitled: UNDERSTANDING CARE COORDINATION ACROSS PRIMARY HEALTH CARE SERVICES IN A RURAL CONTEXT FOR YOUNG CHILDREN AND THEIR FAMILIES EXPERIENCING ADVERSITY: A CRITICAL REALIST CASE STUDY

Abstract: 

This dissertation explores the complex and layered phenomenon of care coordination for young children and their families experiencing adversity in a rural primary health care setting. Despite growing recognition of the importance of coordinated care in addressing health inequities and improving outcomes, families in rural settings often face fragmented services, limited access, and systemic barriers that hinder timely and effective support. Applying critical realism to a case study design, this research investigates the structures, mechanisms, and contextual factors that shape care coordination practices in a rural community in northern British Columbia (BC), Canada. 

A mixed-methods case study approach was employed, combining qualitative interviews with service providers, parents, and caregivers; organizational document analysis; and quantitative service data from medical chart review. The lens of critical realism enabled a layered analysis across three domains: the empirical (what is experienced and observed), the actual (what happens), and the real (the underlying structures and mechanisms that generate outcomes). This critical realist case study approach allowed for a nuanced understanding of the visible practices of care coordination and the often-invisible systemic forces that enable or constrain care coordination activities. 

The study identified four interrelated dimensions of engagement, emotional, cognitive, behavioural, and social, as essential to effective care coordination. Engagement across these dimensions is sustained or disrupted by deeper mechanisms such as trust, system literacy, and relational continuity. The findings reveal that care coordination is a relational and ethical practice shaped by structural fragility, workforce instability, and geographic isolation. The study contributes a novel framework for understanding engagement in care coordination and introduces the concept of moral empowerment as a key enabler of sustained engagement by both families and providers. The dissertation also presents compassionate systems leadership as a strategy for fostering moral empowerment to sustain care coordination. Policy and practice recommendations emphasize the need to invest in relational infrastructure, support interdisciplinary collaboration, and design systems that enable engagement. This research advances understanding of rural care coordination and offers actionable insights to improve equity-oriented, family-centred care in underserved settings.

Defence Committee:

Chair: Dr. Si Transken, University of Northern British Columbia  

Supervisor: Dr. Caroline Sanders, University of Northern British Columbia  

Co-Supervisor: Dr. Margo Greenwood University of Northern British Columbia  

Committee Member: Dr. Shelley Doucet, University of New Brunswick  

Committee Member: Dr. Catharine Schiller, University of Northern British Columbia  

External Examiner: Dr. Clare Harvey, University of British Columbia