C. James Frankish

Challenges of citizen participation in regional health authorities

Citizen participation has been included as part of health reform, often in the form of lay health authorities. In Canada, these authorities are variously known as regional health boards or councils. A set of challenges is associated with citizen participation in regional health authorities. These challenges relate to: differences in opinion about whether there should be citizen participation at all; differences in perception of the levels and processes of participation; differences in opinion with respect to the roles and responsibilities of health authority members; differences in opinion about the appropriate composition of the authorities; differences in opinion about the requisite skills and attributes of health authority members; having a good support base (staff, good information, board development); understanding and operationalizing various roles of the board (governance and policy setting) versus the board staff (management and administration); difficulties in ensuring the accountability of the health authorities; and measuring the results of the work and decisions of the health authorities. Despite these challenges, regional health authorities are gaining support as both theoretically sound and pragmatically based approaches to health-system reform. This review of the above challenges suggests that each of the concerns remains a significant threat to meaningful public participation.

Housing first improves residential stability in homeless adults with concurrent substance dependence and mental disorders.

OBJECTIVES We examined the relationship between substance dependence and residential stability in homeless adults with current mental disorders 12 months after randomization to Housing First programs or treatment as usual (no housing or support through the study). METHODS The Vancouver At Home study in Canada included 2 randomized controlled trials of Housing First interventions. Eligible participants met the criteria for homelessness or precarious housing, as well as a current mental disorder. Residential stability was defined as the number of days in stable residences 12 months after randomization. We used negative binomial regression modeling to examine the independent association between residential stability and substance dependence. RESULTS We recruited 497 participants, and 58% (n = 288) met the criteria for substance dependence. We found no significant association between substance dependence and residential stability (adjusted incidence rate ratio = 0.97; 95% confidence interval = 0.69, 1.35) after adjusting for housing intervention, employment, sociodemographics, chronic health conditions, mental disorder severity, psychiatric symptoms, and lifetime duration of homelessness. CONCLUSIONS People with mental disorders might achieve similar levels of housing stability from Housing First regardless of whether they experience concurrent substance dependence.

Assessment of Communication Barriers in Community Pharmacies

This study identified previously reported facilitators and barriers to pharmacist-client communication and then evaluated their impact on the observed communication behaviors of pharmacists. Pharmacists (n = 100) completed a seven-page questionnaire collecting information on 11 variables that had been organized according to the Policy, Regulatory and Organizational Constructs in Educational and Ecological Development (PROCEDE) model as predisposing, enabling, or reinforcing of pharmacist communication with their clients. Demographic variables also were included. “Communication quality” served as the study’s dependent variable, whereas pharmacist responses served as the independent variables. Communication quality scores for each pharmacist were obtained from the analysis of 765 audio recordings of verbal exchanges occurring between the study pharmacists and their consenting clients during 4-hour, on-site observation periods. Four of the variables examined in the study were found to share a unique relationship with communication quality (pharmacists’ attitude, year of graduation, adherence expectations, and outcome expectations). Hierarchical multiple regression analysis revealed that the variables measured in the questionnaire accounted for 23% of the variance in communication quality scores. Plausible explanations for why the study was unable to capture more of the variance in its proposed relationships and future areas for research are provided.

Implementation of provincial/territorial health goals in Canada

During the past two decades, policy makers in most of Canadas provinces and territories developed broad population-level goal statements about desired health or health and social outcomes. The health goals development process used in each province/territory has been described in government documents and studied by a small number of researchers. However, there is a lack of published research examining the implementation and use of the health goals since they were developed. To begin to fill this gap, we conducted a study between 1998 and 2000 that examined the implementation of provincial/territorial health goals in Canada. Our findings indicate that as the 1990s drew to a close, provincial/territorial health goals were not being used explicitly by policy makers at either provincial/territorial or regional levels in most provinces in Canada to guide health policy and program development, implementation, or evaluation. Instead, the majority of health ministry and regional policy makers were employing strategic/business plans that, at best, reflected or were similar to the original provincial/territorial health goals. Moreover, even though all provinces and the NWT/Nunavut had health goals associated with broad social, economic, and physical environment health determinants, regional-level policy makers were giving priority to health care system goals over all other types of goals. We discuss our findings in relation to studies about health goals in other countries, and we suggest implications that our findings have for both future research and health policy.

SPOUSE-PAIR RISK FACTORS AND CARDIOVASCULAR REACTIVITY

Epidemiological research has identified increased risk for coronary heart disease in Type A men married to well-educated women. The present study examined mechanisms that may explain the increased risk associated with this specific spouse-pair combination. Cardiovascular and self-report responses to an individual, standardized laboratory stress task and a dyadic, interactive affect provocation task were assessed in Type A or B men married to women of either low ( < or = 13 years) or high ( > 13 years) educational levels. Type A men with highly educated spouses (i.e., the highest risk group) also reported the greatest anger-out tendency, high trait anger, and low anger control scores. These men further exhibited elevated diastolic blood pressure at baseline and greater diastolic reactivity specific to the dyadic task than did the men in the lower risk groups. These findings, based on a laboratory study of spousal interactions, support the epidemiological high-risk designation of the Type A man with a highly educated spouse and confirm earlier conceptions that Type A research benefits more from a social interaction approach rather than from an individual trait perspective.

Rapport d’étape - Recenser les interventions axées sur l’équité visant à promouvoir un poids santé

1. Centre for Health Promotion Research, School of Population and Public Health, Université de la Colombie-Britannique, Vancouver (Colombie-Britannique), Canada 2. Centre for Health Evaluation & Outcome Sciences, St. Paul’s Hospital, Providence Health Care, Vancouver (Colombie-Britannique), Canada 3. Agence de la santé publique du Canada, Halifax (Nouvelle-Écosse), Canada 4. Agence de la santé publique du Canada, Ottawa (Ontario), Canada