Suzanne F. Jackson

A Participatory Group Process to Analyze Qualitative Data

Background: When conducting community-based participatory research (CBPR), community researchers are often consulted during the analysis step, but rarely participate in the entire process. Objectives: This paper describes a participatory qualitative data analysis process that was used in three projects with marginalized women in Ontario, Canada. In each project, marginalized women were trained as Inclusion Researchers (IRs) and participated in all stages of the research process. Given the emphasis of the projects on inclusion, it was important that a data analysis process be developed that was group oriented, engaging, understandable, and inclusive of the community researchers. Methods: A five-part analysis process is described including preparation of the data, grouping and coding, consolidation, making sense of the data, and producing a report. This group analysis process took place over 2 full days with facilitation by an academic researcher, Details about the techniques used for each step are described. Conclusions: The strengths of this participatory qualitative data analysis process were that it enabled participation of people with a mixture of levels of education and familiarity with analysis; it enabled community member control of the interpretation; and it could handle large volumes of data quickly. The main limitation was that additional time and procedures would be necessary for a deeper analysis or for groups of over 25 participants. The factors that contributed to the success of this participatory analysis process included accessible and clear procedures, use of visual grouping techniques, and a positive and supportive atmosphere for participation.

A New Realistic Evaluation Analysis Method: Linked Coding of Context, Mechanism, and Outcome Relationships.

In attempting to use a realistic evaluation approach to explore the role of Community Parents in early parenting programs in Toronto, a novel technique was developed to analyze the links between contexts (C), mechanisms (M) and outcomes (O) directly from experienced practitioner interviews. Rather than coding the interviews into themes in terms of context, intervention elements (mechanisms) and outcomes separately and which could be assembled into CMO configurations by the analyst, they were coded as linked dyads and triads directly from the practitioner narratives. Out of all of the linked codes entered, there were a maximum of three with the same combination, presenting challenges for typical qualitative data analysis. This article examines a novel technique that was developed in an attempt to expand this method beyond the circumstances described in the realistic evaluation literature to date. The bulk of the article focuses on the linked coding and analysis procedures, the challenges faced, and the original solutions that were developed to analyze the CMO relations and generate the mid-range theories necessary to move to the next stage of a realist evaluation approach. The features that distinguish this linked coding method from other methods (e.g. Qualitative Comparative Analysis), the major benefits and drawbacks, the utility of the approach within evaluation practice, and its application to realist synthesis and research are discussed.

Ottawa Statement from the Sparking Solutions Summit on Population Health Intervention Research

The Cape Town Statement was released on October 3, 2014 following the Third Global Symposium on Health Systems Research. The Statement covered a number of action themes, including health systems development, capacity development for research, cutting-edge and innovative research methods, and learning communities and knowledge translation. Following the Cape Town Statement’s release, a call to action that included action themes and recommendations for implementation research and delivery science (IRDS) was issued. Directed at health policy-makers and managers, funding organizations, researchers and academic institutions, journal editors and publishers, and civil society organizations, it aimed to facilitate the development of responsive health systems that are effective, efficient, equitable, and people-centered. This call to action is in keeping with the tenets of population health approaches throughout North America, much of Europe, and in many other places around the world. While the Cape Town Statement focused on health systems, the Ottawa Statement emphasizes the science of population health interventions. These include policies, programs and resource distribution approaches that are designed to have impact at the population level by changing the underlying conditions of risk and reducing health inequities. Examples of such interventions with a primary prevention orientation include organizational changes in workplace design, housing policies to reduce homelessness, immunization programs, and tax policy that discourages consumption of tobacco and other harmful products at a population level. Thus, population health intervention research (PHIR) is not clinical or laboratory-based. Rather, it is defined as research that involves the use of scientific methods to produce knowledge about interventions that operate within or outside of the health sector and have the potential to impact the health of populations and health equity (Population Health Intervention Research Initiative for Canada [PHIRIC]).

I WAS HERE: young mothers who have experienced homelessness use Photovoice and participatory qualitative analysis to demonstrate strengths and assets

Inspired by Photovoice, a participatory research methodology, I WAS HERE was a photoblogging workshop in Toronto, Canada, for young mothers who, when they joined, were either homeless or had past experience of homelessness. A participatory qualitative analysis process was developed to support workshop participants in collectively conducting qualitative analysis on a selection of their photoblogs exploring how they view their lives. Five mothers engaged in the participatory qualitative analysis process to categorize their photoblogs into themes. Participants selected over 70 of their personal photoblogs, discussed the meaning of their photoblogs, and categorized them into qualitative themes. One of the mothers continued work on the research by contributing to the write-up of the themes for publication. Participants, through the reflective dialogue, developed nine themes from the photoblogs that describe how they experience motherhood. The resulting nine themes were as follows: ‘Family’, ‘Reality Check’, ‘Sacrifice for Positive Change’, ‘Support’, ‘Guidance’, ‘Growth and Transition’, ‘Proud of Becoming/Being a Mother’, ‘Passing on/Teaching Values’ and ‘Cherished Moments/Reward for Being a Mother’. These themes illustrate the satisfaction that comes from motherhood, strengths and goals for the future, and the desire for support and guidance. The themes developed from this participatory analysis illustrate that young mothers have a positive view of themselves and their ability to be mothers. This constructive view of young mothers provides an alternative to the negative stereotypes commonly attributed to them. This paper also discusses the strengths and challenges of using a participatory analysis approach. As a research methodology, incorporating procedures for participatory qualitative analysis into the Photovoice process provides an effective mechanism to meaningfully engage participants in qualitative analysis. From a health promotion perspective, using the participatory analysis process expanded the Photovoice methodology to facilitate self-reflection and an empowering collective dialogue among a group of women whose strengths and assets are rarely showcased.

Health promotion in Canada: 1986 to 2006

The evolution of health promotion in Canada between 1986 and 2006 is characterized by three major eras: Health Promotion in the Limelight, 1986-1992, Health Promotion Behind the Scenes, 1993-2003, and Health Promotion Restaged, 2003-2006. These eras are illustrated using the Canadian Heart Health Initiative as an example. The first era, backed by strong federal government leadership and support, was a progressive time of developing concepts, collaborations and infrastructure for health promotion across the country. Despite significant progress, by the end of this era, health promotion was neither sufficiently developed nor funded to make it a cornerstone of the health system. In addition, the emphasis was heavily biased towards changing individual behaviour. In the second era, health promotion continued to develop in pockets across the country and debates within the field intensified. However, these events went largely unnoticed and massive overall cuts at federal and provincial levels of government made acute care a much higher priority than health promotion. The third era, mostly shaped by fears linked to public health threats, saw a restaging of health promotion through efforts to strengthen public health infrastructure. Nevertheless, at the end of this era, the necessary intersectoral partnerships (such as in health, housing, education, food, income) remained scarce, and little progress was made to decrease health inequalities. The Canadian Heart Health Initiative was implemented over the same time period as the three eras. Its legacy includes collegial relationships across various levels of government and with non-government organizations, a culture that values pan-Canadian initiatives, and support for integration of research, evaluation, surveillance, policy and practice. It remains to be seen how quickly it will be possible to advance the vision of health promotion conceived during the Limelight Era in Canada. (Promotion & Education, 2007, XIV (4): pp 214-218)

Reflexivity A Methodological Tool in the Knowledge Translation Process

Knowledge translation is a dynamic and iterative process that includes the synthesis, dissemination, exchange, and application of knowledge. It is considered the bridge that closes the gap between research and practice. Yet it appears that in all areas of practice, a significant gap remains in translating research knowledge into practical application. Recently, researchers and practitioners in the field of health care have begun to recognize reflection and reflexive exercises as a fundamental component to the knowledge translation process. As a practical tool, reflexivity can go beyond simply looking at what practitioners are doing; when approached in a systematic manner, it has the potential to enable practitioners from a wide variety of backgrounds to identify, understand, and act in relation to the personal, professional, and political challenges they face in practice. This article focuses on how reflexive practice as a methodological tool can provide researchers and practitioners with new insights and increased self-awareness, as they are able to critically examine the nature of their work and acknowledge biases, which may affect the knowledge translation process. Through the use of structured journal entries, the nature of the relationship between reflexivity and knowledge translation was examined, specifically exploring if reflexivity can improve the knowledge translation process, leading to increased utilization and application of research findings into everyday practice.

Graduate Global Public Health Education: Activities and Outcomes in Relation to Student Prior Experience

The Dalla Lana School of Public Health uses an “add-on” or concentration model of global health education. Records of masters’ graduate cohorts across five disciplinary fields from 2006 to 2009 were classified as to prior experience at application and completion of global health concentration requirements. Alumni from the first two cohorts (2006-08 and 2007-09) were interviewed using a semi-structured interview guide. Prior experience was not linked consistently with the number of elective courses, location of practica or completion of requirements. Successful completion of the global health requirements depended more on the student’s base disciplinary program. Interviewed alumni with medium prior experience reported greater satisfaction with the concentration. Alumni with lower prior experience wanted more courses and support with practica. The pros and cons of a concentration model of global public health graduate education are discussed.

Mainstreaming health promotion

Since the Ottawa Charter in 1986, self-proclaimed health promotion practitioners around the world have worked to promote health using more or less the same five action areas in their organizations and communities. In my opinion, it is a strength of health promotion that health promoters globally can connect to one another in very concrete ways, while at the same time, because there are no strict protocols requiring a limited range of practice, there is a richness of interpretations and actions that reflect the flexibility of the field. Given the range of actions, health promoters can be found everywhere, acting as community developers, organization collaborators, and policy-makers, to name a few examples. This diversity of actions within multiple disciplines has been a strength, but also a liability for the field. I see a key strength of health promotion in what it can contribute to improving health and equity through its political-economic analysis, comprehensive set of strategies, and systems approach to complex problems. By guiding the development of the settings approach in schools, workplaces, hospitals, communities, cities, municipalities, islands and universities, health promotion has demonstrated the success of combining multisectoral collaboration, healthy public policies, community development, and individualized education strategies and making a difference to the health of people living in these settings (1). Over the last 25 years, health promotion has developed a strong but diverse theoretical base, a body of evidence about program effectiveness, and an ability to address complex social problems. By framing health promotion as a systems science and practice, Norman (2) pointed out how health promotion is well positioned to deal with multi-layered, complex interactions, involving multiple communities of interest and diverse populations. This positions health promotion as a field that has something to contribute to conceptualizing, acting, evaluating and researching emerging complex public health problems in a globalized world. On the negative side, health promotion has been portrayed as being so broad that it can include anything, with no clear theoretical base, applicable to too many different kinds of problems and difficult to pin down. For many years, there were complaints that the field lacked evidence of effectiveness, and there are still issues about assessing quality of evidence for health promotion interventions that use mixed methods of evaluation. It has been portrayed as a soft field because it includes participatory approaches and community development strategies. In the health field, still dominated by the medical model, these criticisms keep the collective, participatory, and socio-political aspects of health promotion approaches out of consideration, for the most part. There have been ongoing debates among health promoters about whether we should be identified as a separate profession or whether we should focus our attention on incorporating health promotion in the work of many different disciplines. There are arguments that a more narrowly defined health pro

Proposal for new definition of health

Huber and colleagues rightly challenge the validity, in the 21st century, of the World Health Organization’s definition of health.1 Adaptation and self management are important qualities, but a contemporary definition should include health being a human right protected by certain entitlements and a resource for life that is affected by social, political, economic, and environmental factors.2 …

Understanding Community Resilience Through the Accounts of Women Living in West Bank Refugee Camps

Throughout the West Bank, 19 camps are home to more than 200,000 Palestinians, more than half of whom are female. The Israeli occupation and attendant poverty cause communities inside West Bank camps to live under stress and violence particularly limiting to women. Although often portrayed as “helpless victims of war,” little research has been done to explore how women understand their contributions to the resilience of refugee communities. Female refugees were interviewed about their household roles and community participation. This inquiry shows how female refugees navigate the impacts of gender on community resilience.