The Healthy Heart Kit (HHK) is a risk management and patient education kit for the prevention of cardiovascular disease (CVD) and the promotion of CV health. There are currently no published data examining predictors of HHK use by physicians. The main objective of this study was to examine the association between physicians' characteristics (socio-demographic, cognitive, and behavioural) and the use of the HHK.
All registered family physicians in Alberta (n=3068) were invited to participate in the "Healthy Heart Kit" Study. Consenting physicians (n=153) received the Kit and were requested to use it for two months. At the end of this period, a questionnaire collected data on the frequency of Kit use by physicians, as well as socio-demographic, cognitive, and behavioural variables pertaining to the physicians.
The questionnaire was returned by 115 physicians (follow-up rate = 75%). On a scale ranging from 0 to 100, the mean score of Kit use was 61 [SD=26]. A multiple linear regression showed that "agreement with the Kit" and the degree of "confidence in using the Kit" was strongly associated with Kit use, explaining 46% of the variability for Kit use. Time since graduation was inversely associated with Kit use, and a trend was observed for smaller practices to be associated with lower use.
Given these findings, future research and practice should explore innovative strategies to gain initial agreement among physicians to employ such clinical tools. Participation of older physicians and solo-practitioners in this process should be emphasized.
"Au coeur de la vie" is a research project which aims to evaluate the impact of a heart health dissemination program on primary and secondary prevention practices in local community clinics in the province of Quebec, Canada. Because the project starts in 2001 and no data has been collected to date this paper presents the theoretical model, the objectives of the program, the description of the dissemination procedures, and a brief overview of the evaluation.
Historically, blood pressure control in Hispanics has been considerably less than that of non-Hispanic whites and blacks. We compared determinants of blood pressure control among Hispanic white, Hispanic black, non-Hispanic white, and non-Hispanic black participants (N=32 642) during follow-up in a randomized, practice-based, active-controlled trial. Hispanic blacks and whites represented 3% and 16% of the cohort, respectively; 33% were non-Hispanic black and 48% were non-Hispanic white. Hispanics were less likely to be controlled (
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.
Suboptimum blood pressure is estimated to be the leading risk factor for death worldwide and is associated with 13.5% of deaths globally. The clinical diagnosis of hypertension affects one in four adults globally and is expected to increase by 60% between 2000 and 2025. Clearly, global efforts to prevent and control hypertension are important health issues. While Canada had a prevalence of hypertension similar to that of the United States in the early 1990 s, the treatment and control rate was only 13% compared with 25% in the United States. A national strategic plan was developed, and a coalition of organizations and health care professional and scientist volunteers actively implemented parts of the strategy. Specific initiatives that have evolved include the development of hypertension knowledge translation programs for health professionals, the public and people with hypertension, an outcomes research program to assess the impact of hypertension and guide national-, regional- and community-based knowledge translation interventions, and a program to reduce the prevalence of hypertension by decreasing sodium additives in food. These initiatives have relied on the active involvement of health care professional volunteers, health care professional and scientific organizations and various government departments. There have been large increases in the diagnosis and treatment of hypertension, with corresponding reductions in cardiovascular disease and total mortality associated with the start of the hypertension initiatives. As a result, Canada is becoming recognized as a world leader in the prevention, treatment and control of hypertension.
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The aim of the Population Health Intervention Research Initiative for Canada (PHIRIC) is to build capacity to increase the quantity, quality and use of population health intervention research. But what capacity is required, and how should capacity be created? There may be relevant lessons from the Canadian Heart Health Initiative (CHHI), a 20-year initiative (1986-2006) that was groundbreaking in its attempt to bring together researchers and public health leaders (from government and non-government organizations) to jointly plan, conduct and act on relevant evidence. The present study focused on what enabled and constrained the ability to fund, conduct and use science in the CHHI.
Guided by a provisional capacity-building framework, a two-step methodology was used: a CHHI document analysis followed by consultation with CHHI leaders to refine and confirm emerging findings.
A few well-positioned, visionary people conceived of the CHHI as a long-term, coherent initiative that would have impact, and they then created an environment to enable this to become reality. To achieve the vision, capacity was needed to a) align science (research and evaluation) with public health policy and program priorities, including the capacity to study "natural experiments" and b) build meaningful partnerships within and across sectors.
There is now an opportunity to apply lessons from the CHHI in planning PHIRIC.
The purpose of this paper is to report on the capacity building efforts that took place during the dissemination research phase of Heart Health Nova Scotia (HHNS). HHNS, a health promotion research team, is funded by Health Canada and the Nova Scotia Department of Health. It is located in Halifax, Nova Scotia, a province of 937,000 people situated on the east coast of Canada. It has been a member of the Canadian Heart Health Initiative since its inception in 1989. The first phase of the program, Demonstration, was successfully completed in December 1995 (Heart Health Nova Scotia, 1995). In 1996, HHNS entered its second phase, Dissemination Research, which was conducted between April 1996 and March 2001 in the Western Health Region of Nova Scotia. This was completed in collaboration with organizations, community groups, and government agencies who joined HHNS to form the Heart Health Partnership (HHP) (Heart Health Nova Scotia, 2001). The main aim of this phase of the initiative was to build and research organizational capacity for health promotion and chronic disease prevention.