Natalie Kishchuk

Assessment of the integration of the ecological approach in health promotion programs.

Purpose. This article proposes a model of the ecological approach in health promotion programs. Based on system theory, the model identifies intervention settings and targets as two independent dimensions for assessing the integration of this approach in programs. Additional objectives are to present and pretest an analytical procedure that allows the assessment of integration of the ecological approach in programs. Design. This was a descriptive study of the integration of the ecological approach in a sample of health promotion programs. Subjects. Subjects were 44 health promotion programs drawn from the population of Canadian federally funded programs. Measures. Descriptions of programs were obtained by telephone interviews. A coding scheme was applied to the data to identify intervention settings and targets for each program. Using this information, a summative score of the integration of the ecological approach was estimated for each program. Results. Singh-setting programs were the dominant pattern in the sample. Individuals whose health was of concern were very frequently the direct targets of the programs. However, organizational and interpersonal environments were also often directly targeted. Single-setting or single-intervention strategy programs outnumbered ecological programs. Conclusion. The proposed model and analytical procedure is a useful framework for the assessment of integration of the ecological approach in health promotion programs. The pilot test having been conducted on a convenience sample, future work should replicate the study in a representative sample of programs.

Prevalence and Correlates of Physical Activity Behaviors among Elementary Schoolchildren in Multiethnic, Low Income, Inner-City Neighborhoods in Montreal, Canada

PURPOSE To describe the prevalence and correlates of physical inactivity and of participation in organized sports at and outside school among elementary schoolchildren in multiethnic, low income, urban neighborhoods in Montreal, Canada. METHODS As part of the evaluation of a school-based heart health promotion program, baseline data on physical activity behaviors and potential correlates of these behaviors, were collected from 2285 students aged 9-13 in all 130 grade 4 to 6 classes in 24 inner-city elementary schools from May to June 1993. RESULTS One-fifth of boys (20.5%) and 24.4% of girls were inactive; 40.0% and 33.3% of boys and girls respectively, participated in school sports teams; 82.5% and 74.7% participated in organized sports outside school. Declines in activity levels with age were apparent in both genders. Children who participated in organized sports programs at and outside school, those with higher perceived self-efficacy for physical activity, and those with more parental support for engaging in physical activity were more active. Children of Asian family origin were less active. Socioeconomic status was related to participation in organized sports outside school. CONCLUSIONS To reach children in socio-economically disadvantaged areas and to prevent age-related declines in activity levels, interventions promoting physical activity should focus on increasing availability and access to community-based organized sports programs at and outside school. Also they should include components to increase parental support and to improve perceived self-efficacy for physical activity.

Formative and Effectiveness Evaluation of a Worksite Program Promoting Healthy Alcohol Consumption

Purpose. This project involved the formative and effectiveness evaluation of a program aiming to enable working, nondependent drinkers to consume alcohol in a healthy and socially responsible fashion. Design. A baseline survey (n=387) of employee needs and interests was followed by a formative evaluation testing accessibility, interest/resistance, and potential effectiveness. The formative evaluation used successive iterations of focus groups. The subsequent effectiveness evaluation (n=268) used a randomized pre-post design with three conditions: alcohol program, placebo (nutrition) program, or no program. Settings and Subjects. The program was implemented in a multi-branch, blue-collar, shiftworking organization (n=813) in four Quebec cities with many mobile workers. Intervention. The worksite alcohol program consisted of two, half-hour sessions delivered one week apart by a health professional during paid time. The program provided information on the social and personal costs of alcohol, on strategies for promoting socially responsible drinking, and for the prevention of negative consequences of intoxication for oneself and ones family and friends. Measures. Constructs measured using self-administered questionnaires were: alcohol knowledge, socially responsible attitudes, perceived self-efficacy for drinking management, and self-reported drinking behavior. Results. Despite the lack of interest in the topic (as found in the needs and interests survey), the program was effective in promoting socially responsible attitudes and reducing self-reported weekly consumption among participants. Some placebo effects were also present. Participants were not completely representative of all employees. Conclusion. Worksite alcohol health promotion programs can be effective especially when promoting socially responsible attitudes.

Coeur en santé St-Henri--a heart health promotion programme in Montreal, Canada: design and methods for evaluation.

STUDY OBJECTIVE--This paper describes the objectives, design, and methods of evaluation of the impact of the coeur en santé St-Henri programme, as well as selected results from the evaluation to date. It discusses the possible effects of study design choices made to maintain the impact evaluation within budget. DESIGN--The impact of the programme is evaluated in a community trial which compares the prevalence of cardiovascular disease behavioural risk factors before and after programme implementation in the intervention and a matched comparison community, in both longitudinal cohort and independent sample surveys. In addition, repeated independent sample surveys are conducted in the intervention community to monitor awareness of and participation in the programme. PARTICIPANTS--The baseline sample for both the longitudinal cohort and independent sample surveys included 849 subjects from the intervention community (79.3% of 1071 eligible subjects--8.0% could not be contacted and 12.6% refused) and 825 subjects from the comparison community (77.8% of 1066 eligible subjects--6.6% could not be contacted and 15.6% refused). The two surveys on awareness and participation conducted to date, included 461 (71.0% of 649 eligible subjects) and 387 (67.9% of 570 eligible subjects) subjects respectively from the intervention community. MEASUREMENTS--Baseline data for the longitudinal cohort and independent sample surveys on behavioural risk factor outcomes including use of tobacco, physical activity behaviour, high fat diet, and behaviours related to blood pressure and cholesterol control were collected in 35 minute telephone interviews in both the intervention and comparison communities. Data on awareness of and participation in the programme were collected in 10 minute interviews in the intervention community only in two independent sample surveys conducted seven and 22 months respectively after the baseline survey. RESULTS--With the exception of smoking, the intervention and comparison communities were similar at baseline with regard to the prevalence of behavioural risk factors studied. Awareness of the coeur en santé programme increased from 64.1% in January 1993 to 72.9% 15 months later. Participation in the programme increased from 21.3% to 33.7%. CONCLUSIONS--This paper presents background information on the evaluation of the impact of the coeur en santé programme, as a reference for future publications.

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.

Organizational capacity for chronic disease prevention: A survey of Canadian public health organizations

BACKGROUND There are no national data on levels of organizational capacity within the Canadian public health system to reduce the burden of chronic disease. METHODS Cross-sectional data were collected in a national survey (October 2004 to April 2005) of all 216 national, provincial and regional-level organizations engaged in chronic disease prevention through primary prevention or healthy lifestyle promotion. Levels of organizational capacity (defined as skills and resources to implement chronic disease prevention programmes), potential determinants of organizational capacity and involvement in chronic disease prevention programming were compared in western, central and eastern Canada and across three types of organizations (formal public health organizations, non-governmental organizations and grouped organizations). RESULTS Forty percent of organizations were located in Central Canada. Approximately 50% were formal public health organizations. Levels of skill and involvement were highest for activities that addressed tobacco control and healthy eating; lowest for stress management, social determinants of health and programme evaluation. The few notable differences in skill levels by provincial grouping favoured Central Canada. Resource adequacy was rated low across the country; but was lowest in eastern Canada and among formal public health organizations. Determinants of organizational capacity (organizational supports and partnerships) were highest in central Canada and among grouped organizations. CONCLUSION These data provide an evidence base to identify strengths and gaps in organizational capacity and involvement in chronic disease prevention programming in the organizations that comprise the Canadian public health system.

Integration of the Ecological Approach in Tobacco Programs for Youth: A Survey of Canadian Public Health Organizations:

This study assessed the level of integration of the ecological approach in Canadian public health organizations’ tobacco control programs for youth. The study used a model that identified intervention settings, targets, and strategies as key dimensions of an ecological approach to programs. An inventory of the tobacco youth programs implemented by regional public health organizations identified 148 organizations conducting such programs, 129 of which agreed to participate. Program descriptions were obtained through telephone interviews. The mean number of settings in which programs were implemented was 3 (SD = 1.3), with schools and communities being the most often-used settings. The mean number of different intervention strategies was 3.6 (SD = 1.7). Most frequently, programs directly targeted youths themselves, followed by interpersonal and organizational environment. Overall, the level of integration of the ecological approach was deemed high. Canadian public health organizations’ tobacco control programs aimed at youth are evolving toward a more comprehensive agenda.

A qualitative investigation of organizational issues in an alcohol awareness program for blue-collar workers

Purpose. To explore sociopolitical and organizational issues in worksite alcohol health promotion. Few such programs are reported in the literature. Design. Qualitative data were gathered during the development and implementation phases of a program through focus groups, key informant interviews, and observations made by the research team. Settings and Subjects. One hundred and ninety-nine blue-collar workers from a private company (a group which was also involved in a randomized controlled trial) and 123 workers from four other organizations (nontrial groups) received the intervention. The nontrial groups were used to pilot-test the intervention and in a post-trial assessment. All companies were located in Montreal, Quebec, Canada. Intervention. Two worksite health promotion sessions on responsible drinking were given to small groups of workers. Measures. The reactions of workers, unions, and employers to the program and to the evaluation trial were observed. The viewpoints of key informants were solicited through semi-structured interviews. Analysis was accomplished through several cycles of memo writing. Results. Alcohol is a sensitive subject when discussed in worksite group settings. Our data suggest that there are alcohol problems in the workplace of which coworkers are clearly cognizant. In one setting the intervention led to the development of organizational rules regarding workers who reported to work inebriated, where this behavior had been previously tolerated. The sessions were better received when disease concepts were avoided. Evaluation research on alcohol requires particular care with confidentiality and ongoing communication with all stakeholders, especially unions. Conclusions. Worksite health promotion regarding alcohol is feasible. The complex process of negotiating, implementing, and evaluating a worksite alcohol health promotion program is discussed. More research on the sociopolitical aspects of such programs is needed.

When Anthropology Meets Epidemiology: Using Social Representations to Predict Drinking Patterns

Based on a sample of 2,015 adult drinkers from the Montreal metropolitan area (Quebec, Canada), this study investigates the relationship between eight social representations of drinking (i.e., compensatory, convivial, relaxing, disinhibitory, harmful, sexually enhancing, conventional, socially enabling) and drinking measures (QF Index, drinking frequency, and maximum number of drinks on one occasion) according to age and sex. The representations explain up to 34% of the variance in drinking measures. Representations differed in the strength of their relation to drinking measures and in population prevalence. Strength of relation to drinking and prevalence rates were relatively independent. Representations were generally more strongly endorsed by men than women, although they were related in the same way to drinking behaviors. Representations were also more strongly endorsed by younger than by older respondents, and they related differently to drinking in each age group. The implications of these results for prevention are discussed.

Efficiency of printed materials in worksite health promotion.

Background. Printed health promotion materials are widely believed to be an efficient means of achieving basic health promotion objectives, such as increasing knowledge of risk factors. This study examined the efficiency of cardiovascular health promotion leaflets in reaching employees in a heterogeneous sample of worksites. Methods. Two types of distribution were used: copies of the leaflets were either made available centrally or distributed to each individual employee. Interviews were conducted with 272 employees in six worksites. Respondents were asked whether they recognized, had read, and had learned something from the leaflets. Results. Only one-quarter of respondents recognized the leaflets and only 14% stated that they had learned something. The efficiency of the leaflets was therefore much lower than expected. Z-tests for proportions showed that recognition, reading, and learning were significantly greater among those employees who had been given individual copies of the material. Among those who had been given individual copies, 45 % reported recognizing the leaflet, 36% reading it, and 23% learning something from it. Among those who had only central access, the respective scores were 11%, 7% and 6%. Discussion. These results suggest that the potential cost-effectiveness of printed materials such as leaflets and brochures should be weighed against alternative forms of intervention, given specific program objectives and characteristics of the target population. They also suggest that the cost and effort required in organizing the distribution of individual copies may be recouped in greater penetration.