To present the outcomes of a capacity-building initiative for heart health promotion.
Follow-up study combining quantitative and qualitative methods.
The Western Health Region of Nova Scotia, Canada.
Twenty organizations, including provincial and municipal agencies and community groups engaged in health, education, and recreation activities.
Two strategies were used for this study: partnership development and organizational development. Partnership development included the creation of multilevel partnerships in diverse sectors. Organizational development included the provision of technical support, action research, community activation, and organizational consultation.
Quantitative data included number and type of partnerships, learning opportunities, community activation initiatives, and organizational changes. Qualitative data included information on the effectiveness of partnerships, organizational consultation, and organizational changes.
Results included the development of 204 intersectoral partnerships, creation of a health promotion clearinghouse, 47 workshops attended by approximately 1400 participants, diverse research products, implementation of 18 community heart health promotion initiatives, and increased organizational capacity for heart health promotion via varied organizational changes, including policy changes, fund reallocations, and enhanced knowledge and practices.
Partnership and organizational development were effective mechanisms for building capacity in heart health promotion. This intervention may have implications for large-scale, community-based, chronic-disease prevention projects.
This paper presents an operational definition of capacity building for heart health promotion, instruments developed to measure heart health capacity, and baseline results of capacity for 20 organizations. Qualitative and quantitative research methods were used to collect data. Three instruments were developed to measure organizational capacity for heart health promotion: a survey of community agencies involved in heart health, a questionnaire of organizational practices supportive of heart health promotion, and an interview guide that focused on factors influencing heart health promotion. These instruments proved effective and informed the development of a comprehensive framework for heart health promotion.
Depression is a risk factor for incident coronary heart disease (CHD), and predicts poor prognosis for patients post-myocardial infarction (MI). Few population-based, prospective studies have tested a gradient risk for depressive symptoms on CHD incidence.
The sample (n=1302) was derived from the Nova Scotia Health Survey-1995 (NSHS95), an age- and sex-stratified, random, population-based health survey. All subjects were 45 years or older, free of overt CHD at baseline, and completed the Center for Epidemiological Studies-Depression (CES-D) scale. Covariates included age, sex, body mass index, physical activity level, family history of premature CHD, diastolic blood pressure, lipids, smoking, alcohol use, diabetes, and education level. For the 4 years following NSHS95, MI-related hospitalizations (ICD-9-CM code 410) and CHD-related deaths (ICD-9-CM codes 410-414) were extracted from the provincial, universal healthcare registry.
Fifty-two participants experienced a CHD event. A one standard-deviation increase in CES-D score was associated with a 1.32 hazard risk (confidence interval, 1.01-1.71) of CHD events, controlling for established CHD risk factors.
An independent, gradient association between depression and incident CHD was detected in a population-based sample with complete 4-year CHD data. This evidence supports the value of investigating mechanisms linking depression and CHD.
Epidemiological and experimental studies have suggested that high levels of dietary iron and hemeiron can lead to myocardial injury. Lean meat, a primary source of iron and hemeiron, is promoted because it is lower in fat and cholesterol. Does lean meat put us at risk for myocardial infarction, and should we reconsider its promotion?
We analyzed the importance of dietary iron and hemeiron as a risk for myocardial infarction among 2,198 Nova Scotians who participated in a nutrition survey and who were followed for eight years, using logistic regression.
Acute myocardial infarction incidents occurred in 94 (4.3%) participants. We found no increased risk for myocardial infarction associated with high intake of iron and hemeiron.
Based on Nova Scotian data showing no increased risk for myocardial infarction with high intake of iron and hemeiron, there is no need for immediate reconsideration of promotion of lean meat.
The purpose of this study was to compare the newly released dietary reference intakes with the 1990 Nova Scotia Nutrition Survey and identify characteristics that influence compatibility with these new recommendations. For each of 17 nutrient recommendations, we calculated the proportion of participants who consumed intakes within the recommended range. We constructed a score reflecting overall compatibility between the new recommendations and the Nova Scotia Nutrition Survey data. Using this score as the dependent variable, we conducted multivariate regression analysis to evaluate the importance of demographic and behavioural factors for compatibility with the dietary reference intakes. Results indicate that compatibility with the dietary reference intakes was poor among Nova Scotians, particularly for magnesium, vitamins C and E, and macronutrients. Compatibility was lower among females than among males, and differed independently by age, body mass index, socioeconomic factors, smoking status, and alcohol consumption. Dietary intervention is needed in Nova Scotia. Reduced fat intake and increased intake of specific vitamins should be promoted. We recommend that nutrition education campaigns coinciding with the introduction of the dietary reference intakes in Nova Scotia target younger people, those of lower socioeconomic background, smokers, and those who are obese.
The authors describe the facilitators and challenges to a multi-sectoral initiative aiming at building organizational capacity for heart health promotion in Nova Scotia, Canada. The research process was guided by participatory action research. The study included 21 organizations from diverse sectors. Participant selection for the data collection was purposive. The authors collected data through organizational reflection logs and one-to-one semistructured interviews and used grounded theory techniques for the data analyses. Factors influencing organizational capacity for heart health promotion varied, depending on the project stage. Nonetheless, leadership, organizational readiness, congruence, research activities, technical supports, and partnerships were essential to capacity-building efforts. Approaches to organizational capacity building should be multi-leveled, because organizations are influenced by multiple social systems that are not all equally supportive of capacity.