This study piloted a knowledge translation (KT) intervention promoting evidence-based home care through social interaction. A total of 33 providers organized into 5 heterogeneous, geographically defined action groups participated in 5 researcher-facilitated meetings based on the participatory action model. The KT evidence reflects an empowering partnership approach to service delivery. Exploratory investigation included quantitative pre-post measurement of outcomes and qualitative description of data, presented herein. The critical reflections of the groups reveal macro-, meso-, and micro-level barriers to and facilitators of KT as well as recommendations for achieving KT. Insights gleaned from the findings have informed the evolution of the KT intervention to engage all 3 levels in addressing barriers and facilitators, with a conscious effort to transcend "push" and "pull" tendencies and enact transformative leadership. The findings suggest the merit of a more prolonged longitudinal investigation with expanded participation.
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BACKGROUND: The high rates of cancer among American Indians and Alaska Natives are of growing concern. CONTEXT: In response to high cancer rates, national, state, and tribal organizations have worked to assess knowledge, attitudes, beliefs, and screening practices related to cancer in American Indian and Alaska Native communities and to increase awareness and use of cancer screening. The National Comprehensive Cancer Control Program (NCCCP) of the Centers for Disease Control and Prevention is one such effort. NCCCP's comprehensive cancer control (CCC) planning process provides a new approach to planning and implementing cancer control programs. The CCC process and components for American Indians and Alaska Natives are not yet fully understood because this is a fairly new approach for these communities. Therefore, the purpose of our case study was to describe the CCC process and its outcomes and successes as applied to these communities and to identify key components and lessons learned from the South Puget Intertribal Planning Agency's (SPIPA's) CCC planning and community mobilization process. METHODS: We used interviews, document reviews, and observations to collect data on SPIPA's CCC planning and community mobilization process. CONSEQUENCES: We identified the key components of SPIPA's CCC as funding and hiring key staff, partnering with outside organizations, developing a project management plan and a core planning team, creating community cancer orientations, conducting community cancer surveys, developing a community advisory committee, ongoing training and engaging of the community advisory committee, and supporting the leadership of the communities involved. INTERPRETATION: The CCC planning process is a practicable model, even for groups with little experience or few resources. The principles identified in this case study can be applied to the cancer control planning process for other tribes.
Citizen participation has been included as part of health reform, often in the form of lay health authorities. In Canada, these authorities are variously known as regional health boards or councils. A set of challenges is associated with citizen participation in regional health authorities. These challenges relate to: differences in opinion about whether there should be citizen participation at all; differences in perception of the levels and processes of participation; differences in opinion with respect to the roles and responsibilities of health authority members; differences in opinion about the appropriate composition of the authorities; differences in opinion about the requisite skills and attributes of health authority members; having a good support base (staff, good information, board development); understanding and operationalizing various roles of the board (governance and policy setting) versus the board staff (management and administration); difficulties in ensuring the accountability of the health authorities; and measuring the results of the work and decisions of the health authorities. Despite these challenges, regional health authorities are gaining support as both theoretically sound and pragmatically based approaches to health-system reform. This review of the above challenges suggests that each of the concerns remains a significant threat to meaningful public participation.
In late 2005, 11 major national health organizations decided to work together to build healthier workplaces for healthcare providers. To do so, they created a pan-Canadian collaborative of 45 experts and asked them to develop an action strategy to improve healthcare workplaces. One of the first steps taken by members of the collaborative was to adopt the following shared belief statements to guide their thinking: "We believe it is unacceptable to fund, govern, manage, work in or receive care in an unhealthy health workplace," and, "A fundamental way to better healthcare is through healthier healthcare workplaces. This commentary provides an overview of the Quality Worklife-Quality Healthcare Collaborative action strategy. This strategy embraces the thinking set out by the lead papers in a recent Special Issue of Healthcare Papers (www.Longwoods.com/special_issues.php) focused on developing healthy workplaces for healthcare workers, and brings to Life evidence-informed management practices.
Canadians frequently have recourse to public commissions as a means of dealing with contentious public policy issues. This essay examines the role of philosophers and philosophy in nine such commissions, all of which have dealt with issues in biomedical ethics. The principal findings of this essay are that philosophers have not been used extensively by these commissions, and that the philosophical aspects of the issues under investigation have been dealth with quite inadequately. The essay concludes with suggestions for an expanded role for philosophers in such commissions.
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.
Various hospital payment schemes exist, but none of the schemes fulfil all the objectives of a public payer simultaneously. This implies that trade-offs are involved in the choice of payment scheme. The purpose of this study is to elicit Danish politicians trade-offs in terms of the objectives involved using two elicitation techniques: simple ranking and discrete choice experiments. The implied rankings of the objectives according to the two techniques are compared and reveal discrepancies. The discrepancies may be due to the nature of the techniques and the transparency of the implied ranking to the respondent.