Curated Resources on Multilevel Determinants of Type 2 Diabetes in Ontario Laboratory Practice

Introduction

Type 2 diabetes (T2D) is a complex chronic disease influenced by interacting determinants at individual, interpersonal, organizational, community, and policy levels. This curated resource collection highlights the role of medical laboratory technologists (MLTs) in Ontario, situating diagnostic practice within the Social Ecological Model (SEM) to demonstrate how lab data contributes to patient outcomes, interprofessional collaboration, and system-level interventions for health equity.

Scholarly Resources:

1. The Social Ecological Model (SEM) in Health Promotion

McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377. https://doi.org/10.1177/109019818801500401

Annotation:

This seminal work introduces SEM as a framework for understanding health determinants across multiple levels. It provides theoretical grounding for analyzing T2D through individual, interpersonal, organizational, community, and policy influences, illustrating the nested and interacting factors affecting health outcomes.

2. Bronfenbrenner’s Ecological Theory

Bronfenbrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 32(7), 513–531. https://doi.org/10.1037/0003-066X.32.7.513

Annotation:

Bronfenbrenner’s ecological theory underpins SEM, highlighting how individuals are embedded within interconnected social and structural systems. For MLTs, understanding this nested perspective supports interpretation of lab results in context of patients’ social determinants and community environment.

3. Multilevel Approach to Health Inequalities

Evans, C. R., McFarland, M. J., & Umberson, D. J. (2018). A multilevel approach to modeling health inequalities at the intersection of multiple social identities. Social Science & Medicine, 210, 136–146. https://doi.org/10.1016/j.socscimed.2018.05.034

Annotation:

This study demonstrates how intersecting social identities and structural factors influence health inequities. For T2D in Ontario, it underscores the importance of multilevel analysis when considering disparities in testing, follow-up, and chronic disease management.

4. Digital Communication in Hospital Settings

De Benedictis, A., Lettieri, E., Masella, C., Gastaldi, L., & Macchini, G. (2019). WhatsApp in hospital? An empirical investigation of individual and organizational determinants to use. PLOS ONE, 14(1), e0209873. https://doi.org/10.1371/journal.pone.0209873

Annotation:

Examines digital tools for interprofessional communication in clinical contexts. Demonstrates the importance of interpersonal-level collaboration in interpreting T2D lab data and coordinating care across multidisciplinary teams.

5. Huber et al., Health Redefined

Huber, M., Knottnerus, J. A., Green, L., van der Horst, H., Jadad, A. R., Kromhout, D., … Smid, H. (2011). How should we define health? BMJ, 343, d4163. https://doi.org/10.1136/bmj.d4163

Annotation:

Explores modern conceptions of health that extend beyond biological metrics to include social and systemic determinants. Supports interpretation of laboratory results within broader societal and policy contexts for T2D management.

Government Resources:

1. Public Health Agency of Canada: Social Determinants of Health

Public Health Agency of Canada (PHAC). (2023). Social determinants of health and health inequalities. Government of Canada. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Annotation:

PHAC details structural, community, and personal factors shaping health. It emphasizes that disparities in T2D outcomes are driven by broader social determinants, including income, education, and geographic location, which directly affect access to testing, adherence, and disease control.

2. Ontario Health: Rural Diagnostic Access

Ontario Health. (2024). Improving access to diagnostic testing in rural Ontario. https://www.ontariohealth.ca

Annotation:

This publication describes initiatives to improve equitable access to laboratory testing in underserved areas. It highlights community-level determinants of T2D outcomes and the role of MLTs in extending diagnostics to populations facing geographic and systemic barriers.

3. Ontario Ministry of Health: Published Plans and Annual Reports

Ontario Ministry of Health. (2023). Published plans and annual reports 2023–24: Ministry of Health. https://www.ontario.ca/page/published-plans-and-annual-reports-2023-2024-ministry-health

Annotation:

This resource provides policy-level context for laboratory operations, modernization strategies, and provincial quality standards. It demonstrates how legislation, funding, and system design impact organizational workflows, access to diagnostics, and population-level health outcomes.

4. Diabetes Canada: Statistics in Canada

Diabetes Canada. (2024). Diabetes statistics in Canada. https://www.diabetes.ca

Annotation:

Provides current prevalence data for T2D, emphasizing disparities among older, low-income, and Indigenous populations. This evidence informs targeted, multilevel interventions and illustrates the need for equity-focused laboratory and public health strategies.

Professional and Policy Tool Resources:

1. Accreditation Canada: Medical Laboratory Standards

Accreditation Canada. (2023). Medical laboratory standards overview. https://accreditation.ca

Annotation:

This resource outlines standards for laboratory operations, quality assurance, and workflow management. Adherence ensures reliable testing, supporting accurate diagnostics that inform treatment decisions for T2D and other chronic diseases, thereby influencing patient outcomes and organizational performance.

2. Canadian Society for Medical Laboratory Science: Role of MLTs

Canadian Society for Medical Laboratory Science (CSMLS). (2023). The role of the MLT in Canadian health care. https://www.csmls.org

Annotation:

This resource outlines the responsibilities of MLTs in ensuring accurate, timely diagnostic results. It connects laboratory practice with broader health system outcomes, demonstrating how MLTs serve as critical actors in operationalizing SEM principles for chronic disease management.

3. Quality Assurance and Professional Standards

College of Medical Laboratory Technologists of Ontario (CMLTO). (2024). Quality assurance and professional standards. https://www.cmlto.com

Annotation:

CMLTO guidelines support consistent, high-quality laboratory operations. Adherence ensures reliable testing for T2D and supports organizational-level interventions, reflecting SEM’s emphasis on institutional structures as determinants of health outcomes.

Summary:

This curated resource list demonstrates how T2D outcomes in Ontario are shaped by multilevel determinants, from individual health literacy to policy-level legislation. MLTs are positioned at the nexus of laboratory accuracy, interprofessional collaboration, and population health, translating diagnostic data into actionable interventions. The SEM framework illustrates that interventions targeting single levels are insufficient; meaningful improvements require integrated, multilevel strategies addressing behavioral, organizational, community, and systemic determinants concurrently. Collectively, these resources highlight the critical role of laboratory practice in supporting equitable, patient-centered chronic disease management.