Bev Holmes

An Integrative Framework for Community Partnering to Translate Theory Into Effective Health Promotion Strategy

Introduction. Although there is general agreement about the complex interplay among individual-, family-, organizational-, and community-level factors as they influence health outcomes, there is still a gap between health promotion research and practice. The authors suggest that a disjuncture exists between the multiple theories and models of health promotion and the practitioners need for a more unified set of guidelines for comprehensive planning of programs. Therefore, we put forward in this paper an idea toward closing the gap between research and practice, a case for developing an overarching framework—with several health promotion models that could integrate existing theories—and applying it to comprehensive health promotion strategy. An Integrative Framework. We outline a theoretical foundation for future health promotion research and practice that integrates four models: the social ecology; the Life Course Health Development; the Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation–Policy, Regulatory and Organizational Constructs in Educational and Environmental Development; and the community partnering models. The first three models are well developed and complementary. There is little consensus on the latter model, community partnering. However, we suggest that such a model is a vital part of an overall framework, and we present an approach to reconciling theoretical tensions among researchers and practitioners involved in community health promotion. Integrating the Models: The Need for Systems Theory and Thinking. Systems theory has been relatively ignored both by the health promotion field and, more generally, by the health services. We make a case for greater use of systems theory in the development of an overall framework, both to improve integration and to incorporate key concepts from the diverse systems literatures of other disciplines. Vision for Healthy Communities. (1) Researchers and practitioners understand the complex interplay among individual-, family-, organizational-, and community-level factors as they influence population health; (2) health promotion researchers and practitioners collaborate effectively with others in the community to create integrated strategies that work as a system to address a wide array of health-related factors; (3) The Healthy People Objectives for the Nation includes balanced indicators to reflect health promotion realities and research-measures effects on all levels; (4) the gap between community health promotion “best practices” guidelines and the way things work in the everyday world of health promotion practice has been substantially closed. Conclusions and Recommendations. We suggest critical next steps toward closing the gap between health promotion research and practice: investing in networks that promote, support, and sustain ongoing dialogue and sharing of experience; finding common ground in an approach to community partnering; and gaining consensus on the proposed integrating framework.

What the Public Was Saying about the H1N1 Vaccine: Perceptions and Issues Discussed in On-Line Comments during the 2009 H1N1 Pandemic

During the 2009 H1N1 pandemic, a vaccine was made available to all Canadians. Despite efforts to promote vaccination, the publics intent to vaccinate remained low. In order to better understand the publics resistance to getting vaccinated, this study addressed factors that influenced the publics decision making about uptake. To do this, we used a relatively novel source of qualitative data – comments posted on-line in response to news articles on a particular topic. This study analysed 1,796 comments posted in response to 12 articles dealing with H1N1 vaccine on websites of three major Canadian news sources. Articles were selected based on topic and number of comments. A second objective was to assess the extent to which on-line comments can be used as a reliable data source to capture public attitudes during a health crisis. The following seven themes were mentioned in at least 5% of the comments (% indicates the percentage of comments that included the theme): fear of H1N1 (18.8%); responsibility of media (17.8%); government competency (17.7%); government trustworthiness (10.7%); fear of H1N1 vaccine (8.1%); pharmaceutical companies (7.6%); and personal protective measures (5.8%). It is assumed that the more frequently a theme was mentioned, the more that theme influenced decision making about vaccination. These key themes for the public were often not aligned with the issues and information officials perceived, and conveyed, as relevant in the decision making process. The main themes from the comments were consistent with results from surveys and focus groups addressing similar issues, which suggest that on-line comments do provide a reliable source of qualitative data on attitudes and perceptions of issues that emerge in a health crisis. The insights derived from the comments can contribute to improved communication and policy decisions about vaccination in health crises that incorporate the publics views.

Translating evidence into practice: the role of health research funders

BackgroundA growing body of work on knowledge translation (KT) reveals significant gaps between what is known to improve health, and what is done to improve health. The literature and practice also suggest that KT has the potential to narrow those gaps, leading to more evidence-informed healthcare. In response, Canadian health research funders and agencies have made KT a priority. This article describes how one funding agency determined its KT role and in the process developed a model that other agencies could use when considering KT programs.DiscussionWhile ‘excellence’ is an important criterion by which to evaluate and fund health research, it alone does not ensure relevance to societal health priorities. There is increased demand for return on investments in health research in the form of societal and health system benefits. Canadian health research funding agencies are responding to these demands by emphasizing relevance as a funding criterion and supporting researchers and research users to use the evidence generated.Based on recommendations from the literature, an environmental scan, broad circulation of an iterative discussion paper, and an expert working group process, our agency developed a plan to maximize our role in KT. Key to the process was development of a model comprising five key functional areas that together create the conditions for effective KT: advancing KT science; building KT capacity; managing KT projects; funding KT activities; and advocating for KT. Observations made during the planning process of relevance to the KT enterprise are: the importance of delineating KT and communications, and information and knowledge; determining responsibility for KT; supporting implementation and evaluation; and promoting the message that both research and KT take time to realize results.SummaryChallenges exist in fulfilling expectations that research evidence results in beneficial impacts for society. However, health agencies are well placed to help maximize the use of evidence in health practice and policy. We propose five key functional areas of KT for health agencies, and encourage partnerships and discussion to advance the field.

Communicating about emerging infectious disease: The importance of research

Emerging infectious diseases have taken on renewed significance in the public health sector since the 1990s. Worldwide, governments are preparing emergency plans to guide them; their plans acknowledge that communication will be vital in the event of an outbreak. However, much of the emerging infectious disease communication literature deals with one-way transmission of facts to the public by experts. Little attention is paid to how differently various groups conceptualize risk, or to the idea that there is more to communication than the intentional transfer of information. Emerging infectious disease communication is often based in traditional health promotion or emergency/crisis communication literature, where it is assumed that the only ‘enemy’ is the disease, the right course of action is obvious and the expertise (coming from a public health assumed to be value-free) will not be questioned. Research tends to be limited to exploring barriers to understanding or education, to facilitate better message development. Emerging infectious disease communication research should be broadened to include exploration of implicit assumptions about the nature of the problem at hand (and how to deal with it) as well as the concepts of uncertainty, trust, power, values and biases. Recent risk communication theory, whose focus has historically been on more obviously controversial technological/environmental situations, should guide such research, as it would highlight important contextual factors in which to embed emerging infectious disease communication. This article reviews existing emerging infectious disease communications literature, discusses risk communications theories that could broaden emerging infectious disease communication research, and suggests next steps in a research agenda.

Situating Internet Use: Information-Seeking Among Young Women with Breast Cancer

In recent years considerable attention has been focused on the potential of the Internet as a means of health information delivery that can meet varied health information needs and empower patients. In this article, we explore utilization of the Internet as a means of health information consumption amongst young women with breast cancer who were known Internet users. Focusing on a population known to be competent at using the Internet allowed us to eliminate the digital divide as a possible explanation for limited use of the Internet for health information-seeking. Ultimately, this allowed us to demonstrate that even in this Internet savvy population, the Internet is not necessarily an unproblematic means of disseminating health care information, and to demonstrate that the huge amount of health care information available does not automatically mean that information is useful to those who seek it, or even particularly easy to find. Results from our qualitative study suggest that young women with breast cancer sought information about their illness in order to make a health related decision, to learn what would come next, or to pursue social support. Our respondents reported that the Internet was one source of many that they consulted when seeking information about their illness, and it was not the most trusted or most utilized source of information this population sought.

Media coverage of Canada's obesity epidemic: illustrating the subtleties of surveillance medicine

Obesity was once considered a lifestyle issue; recently it has become an ‘epidemic’. Media coverage presents an opportunity to explore this phenomenon. A framing analysis was conducted on obesity media coverage in one representative Canadian newspaper in 1996, 2000 and 2005/06. The analysis finds that by 2005, an obesity epidemic is unquestioned. However, it does not support others’ findings that obesity is attributed to the decline of western civilization and blamed on lazy individuals who overeat. To relate obesity to such factors flies in the face of capitalistic progress, which demands continued production and consumption. Obesity in Canadian media is presented almost as an opportunity: an obstacle impeding national progress, but one that with a great deal of collective, focused effort, can be overcome. Armstrongs ‘surveillance medicine’, where responsibility for ones health is internalized, focuses the discussion. In turn, the analysis builds on Armstrongs concept, illustrating that the downloading of responsibility to the citizen is not a one-way transfer. The state may benefit by shifting the responsibility for health to the individual, but there are benefits to reclaiming that responsibility at times. An epidemic provides an opportunity to strengthen national pride and enhance an increasingly significant Canadian health research enterprise, thereby stimulating the economy and positioning the country as a world leader. This does not suggest that calling obesity an epidemic serves no population health goals, but simply highlights that by creating a groundswell of concern that in turn justifies immediate action, it does much more.

How funding agencies can support research use in healthcare: an online province-wide survey to determine knowledge translation training needs

BackgroundHealth research funding agencies are increasingly promoting evidence use in health practice and policy. Building on work suggesting how agencies can support such knowledge translation (KT), this paper discusses an online survey to assess KT training needs of researchers and research users as part of a Canadian provincial capacity-building effort.MethodsThe survey comprised 24 multiple choice and open-ended questions including demographics, interest in learning KT skills, likelihood of participating in training, and barriers and facilitators to doing KT at work. More than 1,200 people completed the survey. The high number of responses is attributed to an engagement strategy involving partner organizations (health authorities, research institutes, universities) in survey development and distribution. SPSS was used to analyze quantitative results according to respondents’ primary role, geographic region, and work setting. Qualitative results were analyzed in NVivo.ResultsOver 85 percent of respondents are interested in learning more about the top KT skills identified. Research producers have higher interest in disseminating research results; research users are more interested in the application of research results. About one-half of respondents require beginner-level training in KT skills; one-quarter need advanced training. Time and cost constraints are the biggest barriers to participating in KT training. More than one-half of respondents have no financial support for travel and almost one-half lack support for registration fees. Time is the biggest challenge to integrating KT into work.ConclusionsOnline surveys are useful for determining knowledge translation training needs of researchers, research users and ultimately organizations. In this case, findings suggest the importance of considering all aspects of KT in training opportunities, while taking into account different stakeholder interests. Funders can play a role in developing new training opportunities as part of a broad effort, with partners, to build capacity for the use of health research evidence. Survey results would ideally be complemented with an objective needs assessment based on core competencies, and should be acted on in a way that acknowledges the complexity of knowledge translation in healthcare, existing training activities, and the expertise stakeholders already have but may not refer to as knowledge translation.

Mobilising knowledge in complex health systems : a call to action.

Worldwide, policymakers, health system managers, practitioners and researchers struggle to use evidence to improve policy and practice. There is growing recognition that this challenge relates to the complex systems in which we work. The corresponding increase in complexity-related discourse remains primarily at a theoretical level. This paper moves the discussion to a practical level, proposing actions that can be taken to implement evidence successfully in complex systems. Key to success is working with, rather than trying to simplify or control, complexity. The integrated actions relate to co-producing knowledge, establishing shared goals and measures, enabling leadership, ensuring adequate resourcing, contributing to the science of knowledge-to-action, and communicating strategically.

Communicating During a Pandemic Information the Public Wants About the Disease and New Vaccines and Drugs

To prepare for pandemics, countries are creating pandemic preparedness plans. These plans frequently include crisis communication strategies that recommend conducting pre-crisis audience research to increase the effectiveness and relevance of communication with the public. To begin understanding the communication needs of the public and health care workers, 11 focus groups were conducted in Vancouver, Canada, in 2006 and 2007 to identify what information people want to receive and how they want to receive it. In the event of a pandemic, participants want to know their risk of infection and how sick they could become if infected. To make decisions about using vaccines and drugs, they want information that enables them to assess the risks of using the products. The public prefers to receive this information from family doctors, the Internet, and schools. Health care workers prefer to receive information in e-mails and in-services.

Understanding consumer choices for Ontario produce

Research has demonstrated growing public interest in local food and that this interest is driven by a number of factors including supporting local farmers, reducing the distance food travels, sustaining the environment, and food safety and quality. However, there has been very little research relating factors to actual purchase behavior. This study begins to fill that gap by relating consumer beliefs and values toward local foods with activities that support local foods as well as the actual purchase behavior for 22 fresh produce items. Data were collected through an Ontario-wide, web-based survey that is part of a longitudinal panel regarding food issues. Results from 1879 completed surveys indicated consumers had positive perceptions of local food and felt responsible for buying local, but also experienced barriers when trying to do so. Positive perceptions toward local food and a greater sense of personal responsibility to buy local were positively associated and higher barriers negatively associated with the likelihood of engaging in activities related to supporting local food as well as buying fresh produce items that were produced in Ontario. Implications of these findings are discussed in the context that consumers seem to have an overall orientation or schema to buying local in general, rather than a highly specific schema directed to one or a few particular products.