We report on the feasibility and perceived acceptability of brief motivational interviewing for hazardous alcohol use in an urban Aboriginal health service. General practitioners (GPs) were trained in brief motivational interviewing, and health workers in other aspects of the intervention. Screening was initially carried out using the AUDIT, but subsequently reduced to two simple questions. Information was obtained through a combination of participant observation by the study team, ongoing ad hoc review and feedback from staff, periodic group meetings, and one-on-one interviews with health workers and GPs. The AUDIT was felt to be intrusive and some questions were poorly understood. Brief intervention seemed to be culturally appropriate, but barriers to wider administration included lack of time and the complexity of patients' presenting health problems. As a result of the research there was an increase in general awareness and acceptability of addressing alcohol issues at the health service. This study raises a number of issues that both support and threaten the wide implementation of brief intervention in urban Aboriginal primary care settings.
Health promotion at a community level has gained popularity in recent decades within and outside academic environments. The health promotion discourse is part of a wider political discourse, aimed at empowering individuals to take control of their own lives and enabling them to be engaged, responsible and active citizens in their own communities. Key values of the discourse, deriving from a democratic and individualistic culture, are evident in how local authorities develop and implement policies aimed at promoting population health and wellbeing. In this article, we draw on data from a relatively poor multicultural Danish community incorporated in the WHO Healthy Cities Programme. We explore how key terms of the health promoting discourse are constructed, operationalized and resisted by different subgroups. The contradictions that emerge challenge how we comprehend communities in relation to safety and harmony, and how people within defined communities are involved in common community life.
Public policies may not have been designed to disadvantage certain populations, but the effects of some policies create unintended health inequities. The nature of community health nurses' daily work provides a privileged position to witness the lived experiences and effects of policy-produced social and health inequities. This privileged position requires policy competence including analytical skills to connect lived experiences to public policy. The purpose of this article is to present an example of an urban ethnography that explicates inequity-producing effects of public policy and is intended to inform necessary policy changes. This study sheds light on how issues of childcare, housing, nutrition, and urban infrastructure in the context of poverty are fundamental to the larger issues of environmental health. This policy analysis documents how the Day Care Act of Nova Scotia, Canada explicates patriarchal and neoliberal gender and class assumptions that have implications for mothers' health decisions.