For 1986, 219,470 live births were reported for residents of Canada's 25 Census Metropolitan Areas (CMAs). For each of these births, street address information as shown on the birth registration was used to code the census tract where the mother lived. Data by census tract were obtained for 1,650 infant deaths in 1986, and from the 1986 census for the population of 4,727,770 women aged 10-49 in 1986. Births, infant deaths and census population data (adjusted for undercount) were then used to calculate rates of infant mortality, low birth weight (LBW), very low birth weight (VLBW), prematurity, small for gestational age (SGA), and total fertility. The results are presented by neighborhood income quintile group (based on percentage of low income), and by the mother's age, parity (number of live births), marital status and country of birth, as well as by CMA.
This paper focuses on the implementation evaluation strategy of a smoking prevention program and examines differences in instructional experience and implementation of the grade six curriculum in relation to provider type. Arbaseline, nurses (n = 40), compared with teachers (n = 39), reported (a) less previous classroom teaching experience, (b) greater reliance on lecturing and audio/visual materials, (c) less use of small group classroom activities, and (d) less confidence using small group and role playing methods in the classroom. More nurses than teachers believed smoking to be a significant problem in the schools. Nurses had less confidence than teachers in their ability to teach the smoking prevention curriculum. Nonetheless, behavioural observation indicated that nurses implemented the curriculum more completely. However, teachers, at least those who received workshop training, showed some evidence of greater utilization of teaching styles thought to be desirable.
Continuing professional development--global perspectives: synopsis of a workshop held during the International Association of Dental Research meeting in Gothenburg, Sweden, 2003. Part 1: access, funding and participation patterns.
There appears to have been little previous research interest in continuing professional development (CPD) of dentists and the oral health team. This paper presents data and information on the following aspects of CPD in 17 countries in Asia, Australasia, Europe and North America: availability of different types of CPD, its providers, data on uptake of CPD courses and activities, and funding of CPD. The results indicate that lectures and hands-on skills courses were held in all 17 countries but the use of the Internet to deliver CPD was by no means universal. CPD was funded from a variety of sources including universities, governments and commercial companies. However, the only universal source of funding for CPD was dentists themselves. Data on participation were available from only three countries. Research issues based on these results will be listed in a second paper.
Continuing professional development--global perspectives: synopsis of a workshop held during the International Association of Dental Research meeting in Gothenburg, Sweden, 2003. Part 2: regulatory and accreditation systems and evidence for improving the performance of the dental team.
This paper is the second in a series of two that report on continuing professional development (CPD). Details of the informants and the methodologies used were reported in the first paper. This paper reports the data and information presented on the topics of regulatory and accreditation systems for CPD and evidence that CPD improves the performance of the oral health team. By June 2003, participation in CPD was mandatory in most of the states of the USA, all Canadian Provinces, the UK and Latvia and was likely to become mandatory in a number of other countries in the near future. A variety of accreditation systems were reported including collecting CPD points, which in some countries were weighted depending on the type of CPD activity, and re-certification examinations. Very few studies for the effectiveness of dental CPD were identified. However, in general it was concluded that there is little evidence for the effectiveness of CPD for the oral health team. The main recommendation from this study is that a systematic review of the effectiveness of CPD in improving the performance of the oral health team and patient based outcomes be undertaken. A range of other research questions was also identified including: how can CPD be best matched to clinicians' needs rather than demands?
A strong partnership between researchers and providers is crucial to advance the science of dissemination and to support dissemination of effective chronic disease prevention programs. We reflect on our experience in three recent studies, (a) COMMIT, (b) a National Survey of School Smoking Prevention Programs, and (c) an ongoing study of Training of Providers of Smoking Prevention Programs to identify specific ways in which research and provider communities might collaborate. We propose that a national working group of researchers and providers be established to support (a) dissemination of programs by creating and continuously updating an inventory of 'tested' methods and protocols for use in key community intervention channels (health care offices, worksites, etc.) and (b) dissemination research by establishing a shared set of research priorities and mechanisms to stimulate researcher-provider partnership during the research process.
This study determined the effect of provider (nurse or teacher) and training method (workshop or self-preparation) on outcomes of a social influences smoking prevention program.
One hundred elementary schools were stratified by school risk score (high risk = high smoking rate among senior students) and assigned randomly to conditions: (1) teacher/self-preparation, (2) teacher/workshop, (3) nurse/self-preparation, (4) nurse/workshop, and (5) control. Intervention occurred in grades 6 to 8. Smoking status at the end of grade 8 was the primary endpoint variable.
Intervention reduced grade 8 smoking rates in high-risk schools (smoking rates of 26.9% in control vs 16.0% in intervention schools) but not in low-risk schools. There were no significant differences in outcome as a function of training method and no significant differences in outcome between teacher-provided and nurse-provided interventions in high- and medium-risk schools. Although nurses achieved better outcomes than did teachers in low-risk schools, neither provider type achieved outcomes superior to the control condition in those schools.
Workshop training did not affect outcomes. Teachers and nurses were equally effective providers. Results suggest that programming should target high-risk schools.
Cites: Am J Epidemiol. 1994 Dec 1;140(11):1038-507985652
Cites: J Sch Health. 1994 Oct;64(8):334-97844976
Cites: Can J Public Health. 1996 Nov-Dec;87 Suppl 2:S50-39002344
Cites: Am J Public Health. 1998 Jan;88(1):81-59584038
Cites: Cancer Prev Control. 1997 Aug;1(3):196-2129765745
Cites: Biometrics. 1986 Mar;42(1):121-303719049
Cites: J Behav Med. 1987 Dec;10(6):613-283437450
Cites: Annu Rev Public Health. 1988;9:161-2013288230
Cites: J Sch Health. 1988 Nov;58(9):370-33230877
Cites: J Sch Health. 1989 May;59(5):181-82739360
Cites: Am J Public Health. 1990 Jan;80(1):78-92293810
Cites: Science. 1990 Mar 16;247(4948):1299-3052180065
The issue of practice skills arose in the course of a process evaluation of the Heart Smart North Shore (HSNS) project in British Columbia. We created a Think Tank of researchers and community practitioners to make recommendations for improvement of our skills. These recommendations differed according to different values for health and opinions on how to create health in the community. Because the site reviewers of the HSNS project were clear this was a disease prevention project and not a community development initiative, HSNS's orientation to skill development after the Think Tank moved toward the Precede/Proceed model, the Transtheoretical model and social marketing approaches. The Health Unit has now been restructured into multidisciplinary service teams which must focus on population health, evidence-based practice and the social determinants of health, and thus need to consider health promotion from a community development perspective and empowerment model. We suggest that learning and the development of staff and community volunteers should be seen as a continuous and reflective process that takes place at the individual, community and organizational level.
The three-year "Healthy Hospital" project was designed to increase participatory decision making, thereby decreasing job stress and increasing job satisfaction. Evaluation methods included employee surveys, focus groups and key informant interviews. Overall stress levels, job satisfaction and self-esteem generally improved. The diverse types of evaluation converge on a conclusion that the project achieved modest but significant gains throughout the organization. Lessons for future research and applications are discussed.
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada; School of Population Health, The University of Adelaide, Australia; InSource Research Group, Vancouver, Canada. Electronic address: firstname.lastname@example.org.
Despite the growing significance of health literacy to public health, relatively little is known about how organizational capacity may be improved for planning, implementing and sustaining health literacy interventions. This study aimed to connect decision makers in a public health agency with evidence of how organizational capacity may be improved for delivering health literacy services.
A rapid realist review of published and grey literature was conducted by a partnership between the Public Health Agency of Canada (PHAC) and the InSource Research Group.
Realist review methodology attempts to understand what works for whom under what circumstances, and is characterized by its focus on strategies/interventions, contexts, mechanisms and their relationship to outcome. This review was completed in collaboration with a reference panel (comprised of a broad range of PHAC representatives) and an expert panel. Literature searching was conducted using three databases supplemented with bibliographic hand searches and articles recommended by panels. Data were extracted on key variables related to definitions, strategies/interventions associated with increased organizational capacity, contextual factors associated with success (and failure), mechanisms activated as a result of different strategies and contexts, key outcomes, and evidence cited.
Strategies found to be associated with improved organizational capacity for delivering health literacy services may be classified into three domains: (1) government action; (2) organizational/practitioner action; and (3) partnership action. Government action includes developing policies to reinforce social norms; setting standards for education; conducting research; and measuring health literacy levels. Organizational/practitioner action relates to appropriate models of leadership (both high-level government engagement and distributed leadership). Innovative partnership action includes collaborations with media outlets, those producing electronic materials, community organizations and school-based programs. Contextual factors for success include positive leadership models, interorganizational relationships, and a culture committed to experimentation and learning. Potential mechanisms activated by strategies and contextual factors include increased visibility and recognition of health literacy efforts, enthusiasm and momentum for health literacy activities, reduced cognitive dissonance between vision and action, a sense of ownership for health literacy data, and creation of a common language and understanding.
Government initiated interventions and policies are powerful strategies by which organizational capacity to improve health literacy may be affected. Using the foundations created by the government policy environment, organizations may improve the impact of health literacy interventions through supported distributed leadership.