Blake Poland

Mapping new theoretical and methodological terrain for knowledge translation: Contributions from critical realism and the arts

BackgroundClinical practice guidelines have been a popular tool for the improvement of health care through the implementation of evidence from systematic research. Yet, it is increasingly clear that knowledge alone is insufficient to change practice. The social, cultural, and material contexts within which practice occurs may invite or reject innovation, complement or inhibit the activities required for success, and sustain or alter adherence to entrenched practices. However, knowledge translation (KT) models are limited in providing insight about how and why contextual contingencies interact, the causal mechanisms linking structural aspects of context and individual agency, and how these mechanisms influence KT. Another limitation of KT models is the neglect of methods to engage potential adopters of the innovation in critical reflection about aspects of context that influence practice, the relevance and meaning of innovation in the context of practice, and the identification of strategies for bringing about meaningful change.DiscussionThis paper presents a KT model, the Critical Realism and the Arts Research Utilization Model (CRARUM), that combines critical realism and arts-based methodologies. Critical realism facilitates understanding of clinical settings by providing insight into the interrelationship between its structures and potentials, and individual action. The arts nurture empathy, and can foster reflection on the ways in which contextual factors influence and shape clinical practice, and how they may facilitate or impede change. The combination of critical realism and the arts within the CRARUM model promotes the successful embedding of interventions, and greater impact and sustainability.ConclusionCRARUM has the potential to strengthen the science of implementation research by addressing the complexities of practice settings, and engaging potential adopters to critically reflect on existing and proposed practices and strategies for sustaining change.

The social context of smoking: the next frontier in tobacco control?

A better understanding of the social context of smoking may help to enhance tobacco control research and practice

Quality of internet access: barrier behind internet use statistics

The rapid growth of the Internet is increasingly international with young people being the early adopters in most countries. However, the quality of Internet access looms as a major barrier hidden behind Internet use statistics. The goal of this study was to provide an in-depth evaluation of young peoples perspectives on using the Internet to obtain health information and resources (e-health). Using an inductive qualitative research design, 27 focus groups were conducted in Ontario, Canada. The 210 young participants were selected to reflect diversity in age, sex, geographic location, cultural identity and risk. A major finding was how the quality of Internet access influenced young peoples ability to obtain health information and resources. Quality of Internet access was affected by four key factors: 1. Privacy, 2. Gate-keeping, 3. Timeliness and 4. Functionality. Privacy was particularly relevant to these young people in getting access to sensitive health information (e.g. sexual activities). Variations in access quality also impacted participation in mutual support, fostering social networks and getting specific health questions answered. These results serve as a warning about using Internet penetration statistics alone as a measure of access. Concerted attention is needed on improving the quality of Internet access for achieving the potential of e-health. This is imperative for addressing the digital divide affecting populations both within countries and globally between countries.

Settings for Health Promotion: An Analytic Framework to Guide Intervention Design and Implementation

Taking a settings approach to health promotion means addressing the contexts within which people live, work, and play and making these the object of inquiry and intervention as well as the needs and capacities of people to be found in different settings. This approach can increase the likelihood of success because it offers opportunities to situate practice in its context. Members of the setting can optimize interventions for specific contextual contingencies, target crucial factors in the organizational context influencing behavior, and render settings themselves more health promoting. A number of attempts have been made to systematize evidence regarding the effectiveness of interventions in different types of settings (e.g., school-based health promotion, community development). Few, if any, attempts have been made to systematically develop a template or framework for analyzing those features of settings that should influence intervention design and delivery. This article lays out the core elements of such a framework in the form of a nested series of questions to guide analysis. Furthermore, it offers advice on additional considerations that should be taken into account when operationalizing a settings approach in the field.

Reading Between the Lines: Interpreting Silences in Qualitative Research

Although speech is often the focus of qualitative research, what is not said may be as revealing as what is said, particularly since what is left out ordinarily far exceeds what is put in. The authors explore several potential interpretations of silence, beginning with a focus on silences embedded in interview transcripts, and how these are perceived and managed by researchers and participants. However, the limitations of interview tran scripts become apparent, and the need for a basis for understanding both silences and talk that is not limited to talk itself invites an examination of the role of context and, more specifically, the many structures of talk and interaction that can only be properly understood from an epistemological, theoretical, and methodological orientation that privileges neither structure nor agency, but the dense interpenetration of the two. Several consequences of such a perspective for the interpretation of silences are highlighted.

Becoming a 'real' smoker : cultural capital in young women's accounts of smoking and other substance use

This paper draws from a qualitative study of tobacco use by young women in Toronto, Canada. Narrative interviews were used to understand the multiple roles and functions of smoking within the everyday lives of female adolescents. Guided by a Bourdieusian theoretical framework this study employed the core construct of cultural capital in order to position tobacco and other substance use as field-specific capital that young women accumulate while navigating the social worlds of adolescence. Departing from the psychosocial or peer-influence models that inform the majority of tobacco research with young people, this analysis provides a nuanced understanding of how smoking, drinking, using drugs are much more than simple forms of teenage experimentation or rebellion, but can also serve as key resources for defining the self, acquiring status and making social distinctions within adolescent social worlds. In this context it is also argued that initiation into substance use practices is a way that young women demonstrate and develop social and cultural competencies.

Smoking in the home: changing attitudes and current practices.

OBJECTIVES Trends in attitudes and current practices concerning smoking in the home were examined. METHODS Data from population-based surveys of adults in Ontario, Canada, were analyzed. RESULTS Between 1992 and 1996, the percentage of respondents who agreed that parents spending time at home with small children should not smoke increased from 51% to 70%. In 1996, 34% of the homes surveyed were smoke-free. Smoke-free homes were associated with nonsmoking respondents and with the presence of children and no daily smokers in the home. Only 20% of homes with children and any daily smokers were smoke-free. CONCLUSIONS Efforts are needed to assist parents in reducing childrens exposure to environmental tobacco smoke in the home.

Exclusion, 'Risk', and Social Control- Reflections on Community Policing and Public Health

Abstract With traditional formalized and authoritarian means of social control—legal punishments, deterrence, compliance—rendering ineffective or insufficient, the effective ‘exclusion’ of people and behaviors on the basis of a calculus of ‘risk’ and ‘risk management’ has emerged as a primary mechanism of social control, under the governing umbrellas of local ‘health’ and ‘safety’. Drawing on examples from the arenas of community policing and public health, and more specifically the management of putative ‘risks’ and threats to moral/social order posed by drug use (tobacco smoking) and other ‘disorder’ or ‘public deviance’ phenomena, this paper exploratively examines the processes, technologies, and moral discursive rhetoric behind modes of social control increasingly cast as ‘participatory’, self-reflexive, and ‘community’ based. We offer these reflections in order to stimulte discussion about evolving schemes of governance through public ‘health’ and ‘safety’ regimes in contexts of ‘risk’, and do not intend this as a ‘definitive’ piece on the subject. For these purposes, this paper draws on conceptual work as well as some empirical data from a qualitative study on ‘smokers’ conducted in Ontario, Canada.

Health Psychology and Social Action

This article reviews the main epistemological approaches within health psychology. It considers the approach based on critical realism and various strategies for linking health psychology with social action. It argues that critical health psychology has a distinct contribution to make in promoting public health as part of the broader movement for social justice and health.

A green and healthy future: the settings approach to building health, equity and sustainability

As we move further into the twenty-first century, there is growing realization that the relationship between humans and the wider environment is crucially important, and a recognition that unfettered globalization linked to an increasingly dominant consumer culture has wrought devastating impacts. Within this context, and catalyzed particularly by concerns about climate change, there has also been increased appreciation that public health and the health of the planet are closely interrelated. This article focuses on the opportunities and potential value of encouraging joined-up thinking and integrated action in the settings where people live their lives. Having set the broad context regarding health, equity and sustainability, we scope current activity in relation to ‘greening’ settings before honing in on two concerns: that few such initiatives reflect the holistic and ecological perspective that underpins a settings approach to health promotion, and that work on sustainability and work on health have largely been developed in parallel rather than in an integrated manner. Having discussed these concerns, we propose six principles for progressive practice as a means of grounding a healthy and sustainable settings approach, before concluding by looking to the future and highlighting the likely need and benefits of daring to make more radical changes to our individual, community and working lives.