Using action-research methods and the principles of community development, a small working group initiated an organization-wide process to sensitize the Sunnybrook and Women's College hospital community to the relationship between violence and women's health. In this article, we explore the process by which the initiative was successfully introduced into the newly merged hospital. We describe critical factors for the initiative's success and offer some suggestions on how to maximize opportunities for organizational change.
Using the POPULIS framework, this project estimated health care expenditures across the entire population of Manitoba for inpatient and outpatient hospital utilization, physician visits, mental health inpatient, and nursing home utilization.
This estimated expenditure information was then used to compare per capita expenditures relative to premature mortality rates across the various areas of Manitoba.
Considerable variation in health care expenditures was found, with those areas having high premature mortality rates also having higher health care expenditures.
Significant health problems encountered in adulthood often have their roots in health behaviours initiated during adolescence. In order to reverse this trend, school and health personnel, as well as parents and other community members working with high school students, need to be aware of the health-related beliefs and choices that guide the behaviours of teenagers. Although a wide variety of research has been conducted on this topic among urban adolescents, less is known about the health beliefs and behaviors of adolescents residing in rural areas, particularly in Canada. In general, rural Canadians are less healthy than their urban counterparts. Building on the knowledge and understanding of their own community, key stakeholders were invited to engage in the design and implementation of a participatory action research project aimed at understanding and improving the health of rural adolescents.
A group of parents, teachers, students, school administrators and public health nurses engaged in a participatory action research project to better understand determinants of the health of rural adolescents at a high school in Western Canada. Group members developed and administered a health survey to 288 students from a small rural high school, in an effort to identify areas of concern and interest regarding health practices and beliefs of rural adolescents, and to take action on these identified concerns.
Results indicated some interesting but potentially worrying trends in this population. For example, while frequent involvement in a physical activity was noted by 75.9% of participants, close to half of the females (48%) described their body image as 'a little overweight' or 'definitely overweight', and approximately 25.8% of respondents noted that they skipped meals most of the time. Differences between the genders were apparent in several categories. For example, more girls smoked (16.2%) than boys (12.3%), and more males (55.0%) than females (41%) had tried illegal drugs. Participants indicated awareness of other health-compromising behaviours, including unsafe driving habits and high stress levels, and acknowledged several steps they wanted to take to improve their health, as well as the barriers to taking those steps. Students identified improved nutrition, stress reduction, and increased levels of physical activity as particular important health goals. Students also recommended ways in which information and support could be provided within the school environment to enable them to achieve their health-related goals. Several activities developed in collaboration with students have incorporated the recommendations, and have spawned other activities in response to the ongoing identification of new concerns.
The process of including the rural community in the identification of health assets and needs from the perspective of students -- as well as the planning and implementation of appropriate strategies to address those needs -- demonstrates the strengths inherent within a small rural population. Community members' awareness of the need to create a healthy environment for youth is reflected in their willingness to participate in activities leading to improved health. Greater awareness of the health needs of rural adolescents, and of the influence of gender in some aspects of health behaviors, will help researchers to explore ways in which the unique culture of rural communities can be harnessed to help shape health-focused interventions.
Although HIV/AIDS prevention has presented challenges over the past 25 years, prevention does work! To be most effective, however, prevention must be specific to the culture and the nature of the community. Building the capacity of a community for prevention efforts is not an easy process. If capacity is to be sustained, it must be practical and utilize the resources that already exist in the community. Attitudes vary across communities; resources vary, political climates are constantly varied and changing. Communities are fluid-always changing, adapting, growing. They are "ready" for different things at different times. Readiness is a key issue! This article presents a model that has experienced a high level of success in building community capacity for effective prevention/intervention for HIV/AIDS and offers case studies for review. The Community Readiness Model provides both quantitative and qualitative information in a user-friendly structure that guides a community through the process of understanding the importance of the measure of readiness. The model identifies readiness- appropriate strategies, provides readiness scores for evaluation, and most important, involves community stakeholders in the process. The article will demonstrate the importance of developing strategies consistent with readiness levels for more cost-effective and successful prevention efforts.
Traditionally, quality improvement principles have been used in business and healthcare settings. Nine North American cities, however, have demonstrated how these same QI principles can be applied to improving community health. Guided by a conceptual framework based on a three-question model and employing a Plan-Do-Check-Act cycle, the communities were able to develop interventions that are bringing about change in targeted populations, ranging from reducing the number of suspensions from school due to violence among youths to improving post-neonatal mortality rates.
Erratum In: Qual Lett Healthc Lead 1995 Sep;7(7):15
Prevention research aims to address health and social problems via systematic strategies for affecting and documenting change. To produce meaningful and lasting results at the level of the community, prevention research frequently requires investigators to reevaluate the boundaries that have traditionally separated them from the subjects of their investigations. New tools and techniques are required to facilitate collaboration between researchers and communities while maintaining scientific rigor. This article describes the tribal participatory research approach, which was developed to facilitate culturally centered prevention research in American Indian and Alaska Native communities. This approach is discussed within the broader context of community-based participatory research, an increasingly prevalent paradigm in the prevention field. Strengths and limitations of the approach used in the study are presented.
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Cites: Am J Public Health. 2003 Oct;93(10):1720-714534228
There is growing evidence that population health is influenced by broad socio-environmental factors that require population-focused health promotion strategies. The author reports on a study of the perspectives of public health nurses (PHNs) on the nature of their health promotion practice in the Canadian province of Manitoba, highlighting their perceptions about barriers to population-focused health promotion. A descriptive, exploratory research design was used to conduct standardized open-ended interviews with 24 PHNs in 3 geographically and demographically diverse health authorities. There were remarkable similarities in PHNs' perceptions about their practice. Three categories of barrier to population-focused health promotion were identified: barriers at the level of individual PHNs; organizational barriers (culture, policies, processes); and extra-organizational barriers at the level of the community or province. The results point to a gap between the theory that population-focused health promotion is at the heart of PHN practice and the experience of PHNs at the 3 sites. A concerted effort to address the barriers is needed so that PHNs in Manitoba can play a leadership role in creating a health-care system that truly invests in population health.
There is growing interest in improving population health by multi-sectorial partnerships that address the determinants of health. The Leeds, Grenville and Lanark District Health Unit worked with some 80 other community agencies to form the Lanark, Leeds and Grenville Health Forum in the spring of 2000. The goals of this Health Forum were to evaluate the determinants of health of the population over a five-year period, identify activities within an overall Health Improvement Plan to address these determinants, pursue ongoing resources for interventions, assess their impact on health, and modify plans and activities accordingly. The Health Forum identified that their region had increased mortality rates from cardiovascular disease and cancers compared with the rest of Ontario. The local district health unit offered three possible determinants to explain this: socio-economic determinants (residents below provincial average for income and education), behavioural determinants (residents had higher rates of smoking, sedentary activity and high fat diets) and lack of access to health care. The Health Forum developed a Health Improvement Plan to work on each of these determinants. Throughout its lifetime, the Health Forum proved to be both active and productive, leading to many cooperative ventures. This paper provides a brief overview of the approach taken with its Health Improvement Plan, as well as the successes and limitations of this approach. The experience of the Leeds, Grenville and Lanark Health Forum offers a practical model for public health units to work with partner agencies to address the determinants of health, as well as some insights into the requirements to sustain such a model.