Alberta's integrated approach to chronic disease management programming embraces client-centred care, supports self-management and facilitates care across the continuum. This paper presents strategies implemented through collaboration with primary care to improve care of individuals with chronic conditions, evaluation evidence supporting success and lessons learned from the Alberta perspective.
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.
Cites: Health Care Women Int. 2003 Sep-Oct;24(8):674-9612959868
Cites: Am J Public Health. 2003 Sep;93(9):1517-812948972
Cites: Am J Public Health. 2003 Oct;93(10):1672-914534219
Cites: Am J Public Health. 2003 Oct;93(10):1720-714534228
Unparalleled challenges currently face the Native American health care system. These challenges are a result of several factors, including (a) external pressures to reduce the overall cost of health care in the United States, (b) increased assumption of responsibility for delivery of health care by tribal governments, (c) decreased direct supervision by the Indian Health Service (IHS), (d) insufficient funding for Indian health care, and (e) increased interest of managed care to contract with tribal service units for health care. This article explores the opportunities and challenges facing Native American health care delivery and examines nursing policy issues pertinent to the current state of the IHS.
The focus of this commentary is on the relevance of the Canadian experience for developing countries. It highlights the growing urgency poor countries face in preserving their major human and social capital--community solidarity and family care. Developing countries face a double burden of disease--communicable and non-communicable diseases alike, with very few, and often shrinking, resources. While poorer countries will be able to learn about the essential elements of home-based care from the examples of Canada and other industrialized countries, they do need to develop their own systems based upon their economic, social, political and cultural realities. The primary health care system would seem to provide a foundation for the provision of long-term care on a sustainable and cost-effective basis. In contrast to the often-prevailing practice in developed countries, home-based care services could be integrated into the overall health and social system. Functional disability, regardless of disease aetiology or age of the care recipient, as well as the needs of family caregivers would thus become the defining elements of service eligibility. While the question remains open as to how much poor countries can learn from the experience of others, developing countries do have the opportunity to initiate a rational process where they first provide support to communities and informal caregivers and help to maintain patients in their homes and only later develop other service elements.
Comment On: Healthc Pap. 2000 Fall;1(4):9-3612811170
Cardiovascular disease (CVD) is the leading cause of death in Canadian women. Recent projections suggest that the number of cardiovascular-related deaths among women will continue to increase for at least another decade (Heart & Stroke Foundation of Canada, 2003). Nurses are in pivotal roles to facilitate the development of strategies to promote cardiovascular health and prevent CVD in this population. These strategies must move beyond the current focus on the individual, to encompass the bigger picture of population health promotion. This paper revisits the current state of knowledge of the population-based determinants of cardiovascular health in women, incorporates a Canadian perspective by including relevant epidemiological data, and recommends strategies that extend beyond the individual to the broader community, policy, health services and research domains.
Circles of Support & Accountability (COSA) started 15 years ago in Ontario, Canada, as an alternate means of social support to high-risk sexual offenders released at the end of their sentences without any community supervision. The pilot project in South-Central Ontario has since assisted almost 200 offenders. Projects based on this model are now in place in the United Kingdom, several jurisdictions in the United States, and throughout Canada. Initial research into the efficacy of the COSA pilot project showed that participation reduced sexual recidivism by 70% or more in comparison with both matched controls and actuarial norms. The current study sought to replicate these findings using an independent Canadian national sample. A total of 44 high-risk sexual offenders, released at sentence completion and involved in COSA across Canada, were matched to a group of 44 similar offenders not involved in COSA. The average follow-up time was 35 months. Recidivism was defined as having a charge or conviction for a new offense. Results show that offenders in COSA had an 83% reduction in sexual recidivism, a 73% reduction in all types of violent recidivism, and an overall reduction of 71% in all types of recidivism in comparison to the matched offenders. These findings suggest that participation in COSA is not site-specific and provide further evidence for the position that trained and guided community volunteers can and do assist in markedly improving offenders' chances for successful reintegration.
Within the field of eHealth, there is a shift towards a patient perspective. However, the focus on the patient often fails to acknowledge and achieve a citizen-centric perspective because there is a lack of understanding of the context and complexities of the person and her relations, interests and activities. In this paper we use the persona of 'Citizen Hanne' for two purposes. Firstly, to highlight and provide detail in the understanding of the citizen perspective and thereby facilitate a shift towards a citizen-centric perspective, which is advanced by many in the field of eHealth. Secondly, we want to further nourish a critical goal of highlighting the challenges in doing citizen-centric eHealth and pointing out the barriers for reaching this goal.
This paper presents the organisation, progression, and main findings from a community-based substance use prevention project in five municipalities in western Norway. At the central level, this project was organised with a steering committee and a principal project leader, who is situated at the Department of Health and Social Welfare at the county level. Locally, the way of organizing differed, as one would expect from the community-based model. Top-down/bottom-up strategies can apply both in the way a community organises its efforts, as well as in the relationship between the central project organisation and the participating local communities. It is argued that it can be beneficial for the success of community action programs if one attains a "good mix" between top-down and bottom-up strategies. Factors of importance for such "mix" in the Hordaland project were that the municipalities applied for participation, the availability of economic funding, the venues for meetings between central and local project management, the position of local coordinators, the possibilities for coupling project work to otherwise existing community planning, and the extent of formal bureaucracy.
The goal of the Community Health Action (CHA) model is to depict community health promotion processes in a manner that can be implemented by community members to achieve their collectively and collaboratively determined actions and outcomes to sustain or improve the health and well-being of their community; the community as a whole, for the benefit of all. The model is unique in its ability to merge the community development process with a compatible community assessment, planning, implementation, and evaluation framework. The CHA model supports community participation leading to community-engaged assessment and change. In this article, the CHA model is depicted, its genesis described, and its utility demonstrated.