Kerry Robinson

Developing and Implementing a Triangulation Protocol for Qualitative Health Research

In this article, the authors present an empirical example of triangulation in qualitative health research. The Canadian Heart Health Dissemination Project (CHHDP) involves a national examination of capacity building and dissemination undertaken within a series of provincial dissemination projects. The Projects focus is on the context, processes, and impacts of health promotion capacity building and dissemination. The authors collected qualitative data within a parallel–case study design using key informant interviews as well as document analysis. Given the range of qualitative data sets used, it is essential to triangulate the data to address completeness, convergence, and dissonance of key themes. Although one finds no shortage of admonitions in the literature that it must be done, there is little guidance with respect to operationalizing a triangulation process. Consequently, the authors are feeling their way through the process, using this opportunity to develop, implement, and reflect on a triangulation protocol.

Conceptualizing Dissemination Research and Activity: The Case of the Canadian Heart Health Initiative

Cardiovascular diseases are now the worlds leading cause of death. To reduce high rates of such preventable premature deaths, evidence-based approaches to heart health promotion must be disseminated across public health systems. To succeed, we must build capacity to disseminate strategies that are practical and effective. However, we know little about such dissemination, and we lack both conceptual frameworks to guide our thinking and appropriate scientific methodologies. This article presents conceptual and analytic frameworks that integrate several approaches to understanding and studying dissemination processes within public health systems. This work is based on the Canadian Heart Health Dissemination Project, a research program examining a national heart health dissemination initiative. The primary focus is the development of a systematic protocol for measuring levels of capacity and dissemination, and determining successful conditions for, and barriers to, capacity and dissemination, as well as the nature of the relationship between these key concepts.

Understanding Facilitators of and Barriers to Health Promotion Practice

The health promotion best practices literature is imbued with hope for knowledge mobilization, enhanced practice, and improved population health. Given constrained medical care systems, health promotion is key to reducing the significant burden of chronic disease. However, we have seen little evidence of change. This article investigates facilitators of, and barriers to, three stages of health promotion practice in public health organizations, interagency coalitions, and volunteer committees. The article focuses not on what works but why it does or does not, drawing on five case studies within the Canadian Heart Health Initiative. Results indicate that the presence or absence of appropriately committed and/or skilled people, funds and/or resources, and priority and/or interest are the most common factors affecting all stages of health promotion practice. The article extends the literature on internal and external factors affecting health promotion and highlights strategic influences to consider in support of effective health promotion practice.

Building the backbone for organisational research in public health systems: development of measures of organisational capacity for chronic disease prevention

Background: : Research to investigate levels of organisational capacity in public health systems to reduce the burden of chronic disease is challenged by the need for an integrative conceptual model and valid quantitative organisational level measures. Objective: To develop measures of organisational capacity for chronic disease prevention/healthy lifestyle promotion (CDP/HLP), its determinants, and its outcomes, based on a new integrative conceptual model. Methods: Items measuring each component of the model were developed or adapted from existing instruments, tested for content validity, and pilot tested. Cross sectional data were collected in a national telephone survey of all 216 national, provincial, and regional organisations that implement CDP/HLP programmes in Canada. Psychometric properties of the measures were tested using principal components analysis (PCA) and by examining inter-rater reliability. Results: PCA based scales showed generally excellent internal consistency (Cronbach’s α = 0.70 to 0.88). Reliability coefficients for selected measures were variable (weighted κ(κw) = 0.11 to 0.77). Indicators of organisational determinants were generally positively correlated with organisational capacity (rs = 0.14–0.45, p<0.05). Conclusions: This study developed psychometrically sound measures of organisational capacity for CDP/HLP, its determinants, and its outcomes based on an integrative conceptual model. Such measures are needed to support evidence based decision making and investment in preventive health care systems.

Community Development Approaches to Heart Health Promotion: A Geographical Perspective

This paper reports results of a qualitative study of community development approaches to heart health promotion in Ontario. Cardiovascular disease (CVD) represents a substantial proportion of the burden of illness experienced by western industrialized countries. Biomedical research has implicated lifestyle choices and socioeconomic conditions as primary determinants of CVD. There has been a resultant shift from curative to preventive/health promoting strategies to reduce this burden of illness. The Canadian Heart Health Initiative-Ontario Project (CHHIOP), a two-stage (quantitative and qualitative) longitudinal study, was designed to address issues of heart health promotion through the investigation and strengthening of community-based heart health activities in both the formal and informal public health systems. The study reported on in this paper forms one part of the qualitative stage and focuses on how community relationships and community development approaches play out in local contexts to shape the...

Disseminating Chronic Disease Prevention “to or With” Canadian Public Health Systems

This article follows a conceptual article published in this journal by Elliott et al. and provides an empirical evaluation of the Canadian Heart Health Initiative—Dissemination Phase. Between 1994 and 2005, seven provincial research teams of the Canadian Heart Health Initiative—Dissemination Phase undertook projects to disseminate and evaluate the uptake of evidence-based chronic disease prevention strategies in their respective health systems. In this study, the authors draw from document and stakeholder interview analyses to assess the influence of strategic decisions about dissemination objects, targets, activities, and relationships between knowledge producers and users on the outcomes of chronic disease prevention programming. The findings show that successful dissemination strategies are not necessarily contingent on a high level of fidelity across these dimensions but depend more on the extent to which they are responsive to contextual variables within highly dynamic health systems.

Realistic Expectations: Investing in Organizational Capacity Building for Chronic Disease Prevention

Purpose. This article presents findings that explore investment in organizational capacity building for chronic disease prevention. Specifically, this analysis examines variation in investment inputs, intervention outputs, and capacity changes to inform expectations of health-promotion capacity-building investment. Design/Setting. This multiple case study involving both qualitative and quantitative data is based on seven provincial dissemination projects involved in the Canadian Heart Health Initiative. Methods. Data on investment, number, and type of capacity-building activities and capacity changes come from a questionnaire, key informant interviews, and project report analysis. Quantitative data were analyzed descriptively and for trends, while qualitative data were analyzed thematically. Results. Per capita investments in capacity building ranged from a low of

Using linking systems to build capacity and enhance dissemination in heart health promotion: a Canadian multiple-case study

0.21 in Ontario to

The practice of community development approaches in heart health promotion

167.41 in Prince Edward Island. Multiple, tailored capacity-building interventions were used in each project. Mostly positive but modest changes were observed in at least five dimensions of capacity in all but one project. Conclusion. These findings reveal that capacity building for chronic disease prevention requires a long-term investment and is context specific. Even limited investment can produce interventions that appear to positively influence capacity for chronic disease prevention. The findings also suggest an urgent need to expand surveillance to include indicators of capacity-building investments and interventions to allow policy makers to make more informed decisions about investments in public health.