Patients value health service teams that function effectively. Organizational justice is linked to the performance, health, and emotional adjustment of the members of these teams.
We used a discrete-choice conjoint experiment to study the organizational justice improvement preferences of pediatric health service providers.
Using themes from a focus group with 22 staff, we composed 14 four-level organizational justice improvement attributes. A sample of 652 staff (76 % return) completed 30 choice tasks, each presenting three hospitals defined by experimentally varying the attribute levels.
Latent class analysis yielded three segments. Procedural justice attributes were more important to the Decision Sensitive segment, 50.6 % of the sample. They preferred to contribute to and understand how all decisions were made and expected management to act promptly on more staff suggestions. Interactional justice attributes were more important to the Conduct Sensitive segment (38.5 %). A universal code of respectful conduct, consequences encouraging respectful interaction, and management's response when staff disagreed with them were more important to this segment. Distributive justice attributes were more important to the Benefit Sensitive segment, 10.9 % of the sample. Simulations predicted that, while Decision Sensitive (74.9 %) participants preferred procedural justice improvements, Conduct (74.6 %) and Benefit Sensitive (50.3 %) participants preferred interactional justice improvements. Overall, 97.4 % of participants would prefer an approach combining procedural and interactional justice improvements.
Efforts to create the health service environments that patients value need to be comprehensive enough to address the preferences of segments of staff who are sensitive to different dimensions of organizational justice.
The Norwegian "Campaign Against Home Accidents" was launched nationwide during 1988 to 1991, with the goal of reducing the incidence of home accidents by 20%. The aim of the campaign was to urge primarily the municipal health services to form local accident prevention groups and to implement local measures for prevention of home accidents. On the basis of two surveys, after one year and at the end of the national campaign, an evaluation was carried out concerning the participation of the municipal health services in the campaign and the impact of the campaign on local accident prevention activities. The results indicate that the national campaign engaged the majority of the municipalities and stimulated local accident prevention work to some extent. Most local activities were health education measures, whereas environmental intervention were less commonly reported. Involvement in the campaign was the variable most related to level of accident prevention activities at the end of the campaign period. However, the relationship was only modest. Restricted economical resources, too little emphasis on environmental change, lack of political involvement and insufficient use of coalition partners at the community level are suggested as the major explanations for the limited effect of the campaign.
Injuries due to accidents are a serious public health problem in Sweden as in the rest of the world. In Sweden injuries are the most frequent cause of death among people under the age of 50. More than 75% of all injuries occur in the home or surrounding area. Most accidents strike children, teenagers, and the elderly. Many accidents can be avoided. Prevention is therefore important. A community intervention programme for the prevention of accidents has been developed in the municipality of Sollentuna in Stockholm County. During the planning phase, a basic analysis of the local community was found to be useful, i.e. a Community Diagnosis, which includes three stages: description, analysis, and a health action programme. This report concentrates on the first two stages. To make a community diagnosis, some basic data are needed. In this report the relevance of the existing registers to the Community Diagnosis model is discussed. It is also shown how the Community Diagnosis model helped in the planning phase: the community profile demonstrated whom the prevention should be aimed at, the health profile emphasized the importance of accident prevention, the health risk profile showed where to change the environment, and last, the organizational profile elucidated how preventive work should be organized.
The health and education departments of government share a responsibility for promoting the health of children through policies in the school setting. These policies can be enhanced through the involvement of such stakeholders as school personnel, students, parents or caregivers, health professionals, the non-profit sector and industry. Although there is little evidence-based literature on the roles of stakeholders in school policy development and implementation, stakeholder involvement appears to be critical throughout the policy process. This article discusses stakeholder involvement in the development and implementation of school policies that promote and support healthy eating and physical activity. Canadian examples illustrate stakeholder engagement in this context.
A vast majority of the journeys made by children with disabilities in Sweden are in the family car, which usually is bought and adapted for the child with governmental subsidies. Despite the important philosophical views about accessible vehicles, little is known about the impact of vehicle adaptations on families' lives. The aim of the study was to investigate parent views about the impact of vehicle grants and vehicle adaptation grants on their children's transport mobility and community access.
In total, 434 parents of children with disabilities in Sweden who had received vehicle grants and/or vehicle adaptation grants between 1998-2007 responded to a questionnaire comprising questions with both pre-selected and open-ended answers. A non-responder analysis was performed.
Children with disabilities were found to increase their transport mobility and community access in society as vehicle grants and/or vehicle adaptation grants were given to their parents. Their travel patterns and their travel priorities with their family car indicated that family friends and relatives and leisure activities were frequently visited and prioritised destinations. The grants were linked to access to social and family activities, provided environmental gains and led to increased experienced security. The results also showed that the potential to make spontaneous trips had increased substantially and that families experienced feelings of freedom and enhanced community access. The non-responder analysis confirmed these results.
According to parents, vehicle grants and vehicle adaptation grants for children with disabilities have a positive impact on the children's transport mobility and community access.
Community public health interventions based on citizen and community participation are increasingly discussed as promising avenues for the reduction of health inequalities and the promotion of social justice. However, very few authors have provided explicit principles and guidelines for planning and implementing such interventions, especially when they are linked with research. Traditional approaches to public health programming emphasise expert knowledge, advanced detailed planning, and the separation of research from intervention. Despite the usefulness of these approaches for evaluating targeted narrow-focused interventions, they may not be appropriate in community health promotion, especially in Aboriginal communities. Using the experience of the Kahnawake Schools Diabetes Prevention Project, in Canada, this paper elaborates four principles as basic components for an implementation model of community programmes. The principles are: (1) the integration of community people and researchers as equal partners in every phase of the project, (2) the structural and functional integration of the intervention and evaluation research components, (3) having a flexible agenda responsive to demands from the broader environment, and (4) the creation of a project that represents learning opportunities for all those involved. The emerging implementation model for community interventions, as exemplified by this project, is one that conceives a programme as a dynamic social space, the contours and vision of which are defined through an ongoing negotiation process.
This article explains how a new network of children's health services is evolving in Edmonton within existing hospital facilities. When plans for a free-standing children's hospital for northern Alberta did not prove economically feasible, an alternative was needed that would allow child health needs to be met more effectively within the existing system. The Children's Health Centre of Northern Alberta is the result. Its multidisciplinary, multisite, program-based nature has guided planning and operations from the beginning and has led to its unique strategic organization structure.
This article demonstrates a novel application of propensity score matching techniques: to estimate nonexperimental impacts on program participants within the context of an experimental research design. The author examines the relationship between program participation, defined as qualifying for an earnings supplement by working full-time, and marital union formation among low-income mothers in two Canadian provinces. The author finds that receipt of an earnings supplement substantially increased union formation in one province but not the other. A subgroup analysis based on propensities of program participation revealed that the positive effect on unions was concentrated among relatively disadvantaged participants. The techniques demonstrated in the article are broadly applicable to studies in which take-up is less than 100% among those randomly assigned to a program group.
An evaluability assessment was conducted to plan a community-based, multi-strategy approach to physical activity promotion (MSAPAP) to maximize young children's physical activity in an ethno-racially and socio-economically diverse city. This assessment involved consultation with various stakeholders to develop a program logic model to diagrammatically describe the MSAPAP. First, published literature regarding physical activity was reviewed to describe interventions designed to increase children's physical activity and to identify factors that contributed to program effectiveness. Secondly, key informants from mainstream service organizations and smaller community-based agencies were interviewed to determine their views on how to increase physical activity among children and families. A workgroup developed a draft logic model based on the results of the literature review and community needs assessment results. Thirdly, stakeholders were consulted about the draft model. This consisted of 12 focus groups with members of school boards (two sessions), members of community organizations (three sessions), lay home visitors who provide support to mothers of young children in ethno-racially diverse communities (one session), and parents from six cultural groups (six sessions). The logic model was revised based on the findings from this consultation. The final logic model shows children aged 3-8 years as the main target group, and parents and various community members who influence children as intermediate target groups. The MSAPAP is depicted as six strategies, which are clusters of program activities that are conceptually similar: community engagement, community assessment, accessibility, promotion, education and skill development, and inclusive programming. The logic model shows the 'cause and effect' relationships among program activities, shorter-term outcome objectives (e.g. to reduce user fees for physical activity programs) and longer-term outcome objectives (e.g. to increase the proportion of children who are physically active). The extensive community involvement in planning the MSAPAP facilitated a subsequent plan to develop, implement and evaluate selected program activities in the MSAPAP.