Ardene Robinson Vollman

The Utility of the Transtheoretical Model of Behavior Change for HIV Risk Reduction in Injection Drug Users

The spread of HIV among injection drug users (IDUs) is the second most common mode of transmission next to sexual contact. Although HIV infections can be prevented by changing high-risk behaviors such as needle sharing, these high-risk behaviors are highly complex. Initially developed for smoking cessation, Prochaskas Transtheoretical Model (TTM) is well-suited to the IDU population because it recognizes that chronic behavior patterns are usually under some combination of biological, social, and self-control. The objective of this article is to examine the utility of the TTM for promoting risk reduction behaviors among IDUs. This article will outline (a) the challenges of applying the TTM to IDU behaviors with respect to HIV prevention, (b) the four major components of the TTM as they relate to IDUs, (c) how risk reduction practitioners are currently using the TTM, and (d) current and future research using the TTM.

Feasibility of community-based screening for cardiovascular disease risk in an ethnic community: the South Asian Cardiovascular Health Assessment and Management Program (SA-CHAMP).

BackgroundSouth Asian Canadians experience disproportionately high rates of cardiovascular disease (CVD). The goal of this qualitative study was to determine the feasibility of implementing a sustainable, culturally adapted, community-based CVD risk factor screening program for this population.MethodsSouth Asians (≥ 45 years) in Calgary, Alberta underwent opportunistic cardiovascular risk factor screening by lay trained volunteers at local religious facilities. Those with elevated blood pressure (BP) or ≥ 1 risk factor underwent point of care cholesterol testing, 10-year CVD risk calculation, counseling, and referral to family physicians and local culturally tailored chronic disease management (CDM) programs. Participants were invited for re-screening and were surveyed about health system follow-up, satisfaction with the program and suggestions for improvement. Changes in risk factors from baseline were estimated using McNemar’s test (proportions) and paired t-tests (continuous measures).ResultsBaseline assessment was completed for 238 participants (median age 64 years, 51% female). Mean TC, HDL and TC/HDL were 5.41 mmol/L, 1.12 mmol/L and 4.7, respectively. Mean systolic and diastolic blood pressures (mmHg) were 129 and 75 respectively. Blood pressure and TC/HDL ratios exceeded recommended targets in 36% and 58%, respectively, and 76% were at high risk for CVD. Ninety-nine participants (47% female) attended re-screening. 82% had accessed health care providers, 22% reported medication changes and 3.5% had attended the CDM programs. While BP remained unchanged, TC and TC/HDL decreased and HDL increased significantly (mean differences: -0.52 mmol/L, -1.04 and +0.07 mmol/L, respectively). Participants were very satisfied (80%) or satisfied (20%) with the project. Participants suggested screening sessions and CDM programs be more accessible by: delivering evening or weekends programs at more sites, providing transportation, offering multilingual programs/translation assistance, reducing screening wait times and increasing numbers of project staff.ConclusionsSA-CHAMP demonstrated the feasibility and value of implementing a lay volunteer–led, culturally adapted, sustainable community-based CVD risk factor screening program in South Asian places of worship in Calgary, Alberta, Canada. Subsequent screening and CDM programs were refined based on the learnings from this study. Further research is needed to determine physician and patient factors associated with uptake of and adherence to risk reduction strategies.

A focused ethnographic study of Sri Lankan government field veterinarians' decision making about diagnostic laboratory submissions and perceptions of surveillance.

The global public health community is facing the challenge of emerging infectious diseases. Historically, the majority of these diseases have arisen from animal populations at lower latitudes where many nations experience marked resource constraints. In order to minimize the impact of future events, surveillance of animal populations will need to enable prompt event detection and response. Many surveillance systems targeting animals rely on veterinarians to submit cases to a diagnostic laboratory or input clinical case data. Therefore understanding veterinarians’ decision-making process that guides laboratory case submission and their perceptions of infectious disease surveillance is foundational to interpreting disease patterns reported by laboratories and engaging veterinarians in surveillance initiatives. A focused ethnographic study was conducted with twelve field veterinary surgeons that participated in a mobile phone-based surveillance pilot project in Sri Lanka. Each participant agreed to an individual in-depth interview that was recorded and later transcribed to enable thematic analysis of the interview content. Results found that field veterinarians in Sri Lanka infrequently submit cases to laboratories – so infrequently that common case selection principles could not be described. Field veterinarians in Sri Lanka have a diagnostic process that operates independently of laboratories. Participants indicated a willingness to take part in surveillance initiatives, though they highlighted a need for incentives that satisfy a range of motivations that vary among field veterinarians. This study has implications for the future of animal health surveillance, including interpretation of disease patterns reported, system design and implementation, and engagement of data providers.

A focused ethnographic study of Alberta cattle veterinarians' decision making about diagnostic laboratory submissions and perceptions of surveillance programs.

The animal and public health communities need to address the challenge posed by zoonotic emerging infectious diseases. To minimize the impacts of future events, animal disease surveillance will need to enable prompt event detection and response. Diagnostic laboratory-based surveillance systems targeting domestic animals depend in large part on private veterinarians to submit samples from cases to a laboratory. In contexts where pre-diagnostic laboratory surveillance systems have been implemented, this group of veterinarians is often asked to input data. This scenario holds true in Alberta where private cattle veterinarians have been asked to participate in the Alberta Veterinary Surveillance Network-Veterinary Practice Surveillance, a platform to which pre-diagnostic disease and non-disease case data are submitted. Consequently, understanding the factors that influence these veterinarians to submit cases to a laboratory and the complex of factors that affect their participation in surveillance programs is foundational to interpreting disease patterns reported by laboratories and engaging veterinarians in surveillance. A focused ethnographic study was conducted with ten cattle veterinarians in Alberta. Individual in-depth interviews with participants were recorded and transcribed to enable thematic analysis. Laboratory submissions were biased toward outbreaks of unknown cause, cases with unusual mortality rates, and issues with potential herd-level implications. Decreasing cattle value and government support for laboratory testing have contributed to fewer submissions over time. Participants were willing participants in surveillance, though government support and collaboration were necessary. Changes in the beef industry and veterinary profession, as well as cattle producers themselves, present both challenges and opportunities in surveillance.

Public Participation for Women's Health: Strange Bedfellows or Partners in a Cause?

A major focus of health system reform in Canada has been the regionalization of health services administration. With a goal of bringing decision-making closer to the community, there has been a commitment to public participation in planning by some health authorities. Women, however, often feel that their participation is minimal or their needs are not addressed. During regionalization of the Alberta health system, the Calgary Health Region (CHR) negotiated an agreement with the Salvation Army to provide womens health services through the Grace Womens Health Centre, a major part of the regions womens health program. We present a case study exploring the process and final agreement and the impact of this agreement on womens participation in health policy development. The historical context and the nature and impact of the agreement are described and several participation strategies that occurred within the partnership are discussed. The development of a formal partnership agreement, a governance model, was a success for public participation in this case; however, the greatest success for women was maintenance of a political space in which womens health as a priority could be discussed in a context where the forces against gender equity talk are strong.

Ethical Review of Health Promotion Program Evaluation Proposals

Some policies state that program evaluation falls within the domain of administrative research that does not require review by an ethics review board. We propose that some health promotion program evaluations include at least one element of research and can be distinguished from quality assurance. Although American and Canadian evaluation societies provide important guidelines and standards for evaluation practitioners, processes for accountability to the public are provided by research ethics boards. The field of health promotion is, by its nature, replete with challenges to existing research ethics boards. Given the dearth of published literature on the ethics of health promotion evaluation or practice, the field could benefit from the open debate that reviews of proposals would encourage.

Using Mixed Methods to Facilitate Complex, Multiphased Health Research

From conceptualization to application and evaluation, research is conducted in a context of increasing complexity of disciplines, goals, communities, and partnerships. Researchers often are challenged to demonstrate the rigor of their methods and results to audiences with diverse backgrounds and disciplinary expertise. This article illustrates the benefits of using mixed methods approaches in research designed to address issues in complex research projects. It outlines the implementation of a private, public, and academic partnership, where scientific merit of methods and results was a critical foundation to the development of public policy. The overall goal of the Public Health Leadership Competencies Project (the Project) was to identify public health leadership competencies that could apply to public health practice across the country. This research demonstrates how mixed methods research in public health might be of perceived benefit to complex projects. The Project included challenges and opportunities through multiple phases of data collection and participation of members from each of the seven disciplines in public health (i.e., public health dentists, physicians, dietitians, and nurses, as well as epidemiologists, health promoters, and environmental health inspectors). The discussion addresses challenges of a national project, the complex organizational framework within which we were directed to work, and the lessons associated with using multiple sources of data.

Evaluating Qualitative Health Research from Inside and Outside

Existing literature documents criteria for ensuring rigor for qualitative research (e.g., Cohen and Crabtree. Annal Fam Med 6: 331–339, 2008; Morse et al. 2001; Morse et al. Int J Qual Method 1: 13, 2002). Given the important role of recognition of the determinants of health in the realm of health research and the contributions of qualitative research to health evidence, there is an ongoing need for clarity. Strategies of verification are internal to the research process, and are the responsibility of the researchers and their team. The techniques used in the verification process incrementally contribute to the validity of the research (Meadows and Morse. The nature of qualitative evidence. Thousand Oaks, CA: Sage, 2001). Similarly traditional and evolving strategies have been established for the validation process.