Michelle M. Vine

Examining local-level factors shaping school nutrition policy implementation in Ontario, Canada

OBJECTIVE Increasing numbers of overweight and obese youth draw attention to the school as an important setting for targeted nutrition interventions, given that it is where they spend a majority of their waking time. The objective of the present study was to explore local-level factors shaping the implementation of a school nutrition policy. DESIGN In-depth, semi-structured interviews were conducted in person or via the telephone (a maximum of 60 min). An interview guide was informed by the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, research objectives and literature. Key themes centred on policy implementation, including facilitators and barriers (i.e. resources, capacity), user satisfaction (i.e. students) and communication strategies. SETTING Secondary schools in Ontario, Canada. SUBJECTS Twenty-two participants from local agencies supporting school nutrition programming (n 8) and secondary-school principals, vice principals and teachers (n 14) from nine schools across three Ontario school boards. RESULTS Results are organized according to environments outlined in the ANGELO framework. The cost of healthy food for sale, revenue loss (economic), proximity of schools to off-site food outlets (physical), the restrictive nature of policy, the role of key stakeholders (political), the role of stigma and school culture (sociocultural) act as local-level barriers to policy implementation. CONCLUSIONS Gaps in policy implementation include the high cost of food for sale and subsequent revenue generation, the close proximity of internal and external food environments, the need for consultation and communication between stakeholders, and strategies to reduce stigma and improve the school nutrition culture.

Exploring the school nutrition policy environment in Canada using the ANGELO framework.

Excess body weight has become a major public health issue. Given the link between poor nutrition, obesity, and chronic disease in youth, increasing attention is being paid to the school as an ideal setting for promoting nutritious eating practices. Informed by the ANGELO (Analysis Grid for Environments Linked to Obesity) framework, we employ a documentary analysis to investigate the context of school nutrition in Canada, particularly the relationship between regional- and upper-level policies. In doing so, we examine policy documents and technical reports across three levels. We used mixed methods to analyze relevant English language policy documents and technical reports across Canada (n = 58), published between 1989 and 2011. Results reveal distinct differences across federal, provincial, and regional levels. The availability of nutritious food in schools and having nutrition education as part of the curriculum were key components of the physical environment across federal and provincial levels. Federal and provincial priorities are guided by a health promotion framework and adopting a partnership approach to policy implementation. Gaps in regional-level policy include incorporating nutrition education in the curriculum and making the link between nutrition and obesity. Policy implications are provided, in addition to future research opportunities to explore the connections between these environments at the local level.

To disrupt and displace: placing domestic violence on the public health agenda

In 1996, in Geneva, the World Health Assembly declared the violence as a major and growing public health problem. Others have gone further in describing (sexual) violence against women as a weapon of terror. In the local community of Hamilton, Ontario Canada (population approximately 500,000), domestic violence represents 25% of the workload of the local police service. The literature has shown that violence in general, and domestic violence in particular, presents tremendous social and health impacts for individuals and communities. In this local community, however, an evaluation of a recently piloted cutting edge domestic violence response system highlights how difficult it is to place domestic violence on the policy and/or public health agendas. Qualitative interviews with 23 key stakeholders were undertaken to assess their views on the success of the program. While overall findings indicate that the success of this brief (11 month) pilot project was limited, important insights emerged around responding to the domestic violence issue, at the community level.

Fostering Collaborative Teaching and Learning Scholarship through an International Writing Group Initiative.

ABSTRACT The research presented here explored the experiences of participants in an international collaborative writing group (ICWG) initiative that ran in conjunction with the 2012 International Society for the Scholarship of Teaching and Learning (ISSoTL) conference. The ICWG sought to cultivate collaborative pedagogical scholarship by bringing together a range of international academics to co-author articles on teaching and learning topics of shared interest. Data were collected via online surveys at the beginning and end of the initiative and interim focus groups/interviews. In addition to suggesting that the ICWG is an effective means of fostering collaborative writing, the results point to a number of factors that might also influence collaboration in other contexts: modes of collaboration, opportunities for social dialogue, developing a shared vision and voice, and leadership. Implications and applications of the findings, as well as areas of further research, are discussed.

“Now What?” Perceived Factors Influencing Knowledge Exchange in School Health Research:

Increasing the uptake of school health research into practice is pivotal for improving adolescent health. COMPASS, a longitudinal study of Ontario and Alberta secondary students and schools (2012-2021), used a knowledge exchange process to enhance schools’ use of research findings. Schools received annual summaries of their students’ health behaviors and suggestions for action and were linked with a knowledge broker to support them in making changes to improve student health. The current research explored factors that influenced COMPASS knowledge exchange activities. Semistructured interviews were conducted with researchers (n = 13), school staff (n = 13), and public health stakeholders (n = 4). Interestingly, knowledge users focused more on factors that influenced their use of COMPASS findings than factors that influenced knowledge brokering. The factors identified by participants are similar to those that influence implementation of school health interventions (e.g., importance of school champions, competing priorities, inadequate resources). While knowledge exchange offers a way to reduce the gap between research and practice, schools that need the most support may not engage in knowledge exchange; hence, we must consider how to increase engagement of these schools to ultimately improve student health.

Assessing a community-based asthma education intervention

Asthma prevalence has increased dramatically in western countries in the last 25 years, and it has been estimated that allergies and asthma affect 30 to 35% of the Canadian population. It has been generally estimated that there are approximately 714,000 Canadians diagnosed with chronic obstructive pulmonary disease (COPD), but it is also estimated that 50% of affected individuals remain undiagnosed, suggesting that there are over 1.4 million Canadians suffering from COPD. The literature has shown that asthma, associated allergies and COPD present tremendous social and health impacts for both individuals and communities; however, a recently piloted community-based asthma education program underscores how difficult it is to increase patient awareness and knowledge about asthma, associated allergies and COPD, improve early detection of these diseases, and therefore improve quality of life and overall chronic disease management. Quantitative surveys, along with asthma, allergy and COPD assessments (peak flow testing) were undertaken to ascertain participants’ levels of asthma/COPD, knowledge of these diseases, and disease management strategies. Additional findings from a follow-up survey helped to confirm these findings. Overall, preliminary findings reveal that the pilot’s success was limited. Barriers and facilitators to community-based asthma, allergy and COPD education and awareness, peak flow screening, and strategies to encourage proper chronic disease prevention and management, are discussed in this presentation. Key Priority Areas 1- Chronic disease 2- Physical and built environment 3- Public health workforce development

Can knowledge exchange support the implementation of a health-promoting schools approach? Perceived outcomes of knowledge exchange in the COMPASS study

BackgroundDespite the potential population-level impact of a health-promoting schools approach, schools face challenges in implementation, indicating a gap between school health research and practice. Knowledge exchange provides an opportunity to reduce this gap; however, there has been limited evaluation of these initiatives. This research explored researchers’ and knowledge users’ perceptions of outcomes associated with a knowledge exchange initiative within COMPASS, a longitudinal study of Canadian secondary students and schools. Schools received annual tailored summaries of their students’ health behaviours and suggestions for action and were linked with knowledge brokers to support them in taking action to improve student health.MethodsQualitative semi-structured interviews were conducted with COMPASS researchers (n = 13), school staff (n = 13), and public health stakeholders (n = 4) to explore their experiences with COMPASS knowledge exchange. Key issues included how knowledge users used school-specific findings, perceived outcomes of knowledge exchange, and suggestions for change.ResultsOutcomes for both knowledge users and researchers were identified; interestingly, knowledge users attributed more outcomes to using school-specific findings than knowledge brokering. School and public health participants indicated school-specific findings informed their programming and planning. Importantly, knowledge exchange provided a platform for partnerships between researchers, schools, and public health units. Knowledge brokering allowed researchers to gain feedback from knowledge users to enhance the study and a better understanding of the school environment. Interestingly, COMPASS knowledge exchange outcomes aligned with Samdal and Rowling’s eight theory-driven implementation components for health-promoting schools. Hence, knowledge exchange may provide a mechanism to help schools implement a health-promoting schools approach.ConclusionsThis research contributes to the limited literature regarding outcomes of knowledge brokering in public health and knowledge exchange in school health research. However, since not all schools engaged in knowledge brokering, and not all schools that engaged discussed these outcomes, further research is needed to determine the amount of engagement required for change and examine the process of COMPASS knowledge brokering to consider how to increase school engagement.

Assessing a Population-Based Approach to Asthma and COPD Education The PLATE Program

In 2008, chronic respiratory disease—including asthma and chronic obstructive pulmonary disease (COPD)—was the fourth leading cause of death in Canada. Chronic respiratory disease represents a majo...

Assessing a population-based approach to the management of respiratory disease

The prevalence of respiratory disease (asthma, allergies and COPD) has increased dramatically in the last 25 years, with a heavy economic and social burden. Provision of information is recognized as a means to improve patient knowledge and self-management skills, and can overall result in improved disease management and quality of life. The Partnership in Lung Age Testing and Education (PLATE) Programme was a one-year demonstration project designed to investigate the effectiveness of a population-based approach to the management of respiratory disease. The PLATE objectives were: to improve patient education and disease management skills; increase public awareness about respiratory disease; and promote a healthy lifestyle. During phase one, 13 Airways Clinics were established in Toronto and Hamilton at various community settings (e.g. pharmacies, shopping malls, libraries), providing community residents with respiratory health education, which aimed to improve the implementation of best practices for chronic disease management through clinical assessments, peak flow testing, and follow-up with regular health care providers. Project participants were categorized into three groups: 1) with physician-diagnosed asthma (61%); 2) with physician-diagnosed COPD (11%); and 3) with respiratory symptoms, but without a diagnosis and/or long-time smokers (28%). More than half (60%) of the participants were female; over 75% were over the age of 40 years. Participants were provided with an educational kit to encourage ongoing education for management of their chronic disease. Phase two is currently under-way and includes a community outreach component, in addition to a follow-up survey to examine changes in the levels of knowledge gained from phase one. Despite the small sample size (87 participants), findings indicate that the highest level of interest came from high-needs communities, and that pharmacies are the most appropriate setting within which to host clinics, while shopping malls are best for information displays. More research is needed to confirm these findings.