Wilfreda E. Thurston

Bridging the divide between families and health professionals' perspectives on family-centred care

Objectives  To describe and discuss key findings from a recent research project that challenge an increasingly prevalent theme, apparent in both family‐centred care research and practice, of conceptualizing family‐centred care as shifting care, care management, and advocacy responsibilities to families. The purpose of the research, from which these findings emerged, was to develop a conceptualization of family‐centred care grounded in the experiences of families and direct health‐care providers.

An ecological model for understanding culture as a determinant of women's health

In combination with gender and culture, the authors argue that the migratory experience must be considered as a determinant of the health of immigrant women in its own right. Gender and other symbolic institutions are seen as intertwined in an ecological model of health. Bronfenbrenners (1986) systems theory and a combination of theories of social cognition, social exchange and symbolic interaction articulated by Howard and Hollander (1997) expand the ecological model. Cognitive schemas of gender and culture help explain the process of integration in a new locality over time. Success in addressing the health of immigrant women will be limited if the impact of migration and at the meso- and macro-levels is ignored in favour of a focus on the individual.

Efficacy of a Sexual Assault Resistance Program for University Women

BACKGROUND Young women attending university are at substantial risk for being sexually assaulted, primarily by male acquaintances, but effective strategies to reduce this risk remain elusive. METHODS We randomly assigned first-year female students at three universities in Canada to the Enhanced Assess, Acknowledge, Act Sexual Assault Resistance program (resistance group) or to a session providing access to brochures on sexual assault, as was common university practice (control group). The resistance program consists of four 3-hour units in which information is provided and skills are taught and practiced, with the goal of being able to assess risk from acquaintances, overcome emotional barriers in acknowledging danger, and engage in effective verbal and physical self-defense. The primary outcome was completed rape, as measured by the Sexual Experiences Survey-Short Form Victimization, during 1 year of follow-up. RESULTS A total of 451 women were assigned to the resistance group and 442 women to the control group. Of the women assigned to the resistance group, 91% attended at least three of the four units. The 1-year risk of completed rape was significantly lower in the resistance group than in the control group (5.2% vs. 9.8%; relative risk reduction, 46.3% [95% confidence interval, 6.8 to 69.1]; P=0.02). The 1-year risk of attempted rape was also significantly lower in the resistance group (3.4% vs. 9.3%, P<0.001). CONCLUSIONS A rigorously designed and executed sexual assault resistance program was successful in decreasing the occurrence of rape, attempted rape, and other forms of victimization among first-year university women. (Funded by the Canadian Institutes of Health Research and the University of Windsor; SARE ClinicalTrials.gov number, NCT01338428.).

Evaluability Assessment: A Tool for Incorporating Evaluation in Social Change Programmes

In this article we discuss the evaluation of a particular type of health promotion programme where social change is a central theme of programme development, implementation and evaluation. Evaluation of social change programmes requires a politics of accountability and a utilization focus. These require a process of planning evaluations that mirrors the process of programme planning and implementation. Such an approach must be open to the possibility that the demands on evaluation research may change over the lifecycle of the programme. We propose an evaluability assessment framework as a participatory tool for planning evaluations that meet the need for credible evaluative accounts of social change and contribute to social change. This framework is a tool that can be used at any time to plan and review evaluations.

Balancing Culture, Ethics, and Methods in Qualitative Health Research with Aboriginal Peoples:

Including Aboriginal women in qualitative health research expands our understanding of factors that contribute to their health and well-being. As part of the larger WHEALTH study, we gathered qualitative health data on midlife Aboriginal women living both on and off reserves. Despite careful planning and a commitment to methodological congruence and purposiveness we encountered a number of challenges that raised ethical questions. We present how we addressed these issues as we attempted to produce ethical, culturally sensitive, and sound research in a timely fashion. This article provides important considerations for other researchers and funding bodies while illustrating the benefits of working with Aboriginal women as an under researched population.

Evaluability assessment. A catalyst for program change and improvement.

Using a local cross-cultural health service program as a framework, the authors describe the process of an evaluability assessment (EA) and illustrate how it can be a catalyst for program change. An EA is a process that improves evaluation. The key product was a logic model, which traces the links between objectives, activities, and outcomes. Four key insights emerged. First, the distinction of who was included and excluded in the target population, originally ambiguous, was clearly defined. Second, through the development of the logic model, staff members were able to analyze their goals and assumptions and critically explore possible gaps between expected outcomes and activities. Third, the EA enabled reflection on and clarification of both process and outcome measures. Finally, global goals were pared down to better match the project capacity. Developing an evaluability assessment was a cost-effective way to collaborate with staff to develop a clearer, more evaluable project.

Health Promotion and Preventive Measures: Interpreting Messages at Midlife

In this article, the authors provide important insight into the cultural messages that midlife women receive about preventive health care. Data were collected from 24 rural women as part of an ongoing project on midlife women’s health. Kleinman’s model of the popular and professional health care sectors was used to examine the data. There is clear evidence of clashes between the orientations and expectations of these sectors. Women’s experiences reveal some consistent themes that contextualize their preventive health pursuits: time constraints, claims for expert knowledge, salience of family history, and the inclusion of nonallopathic resources as part of the professional realm. At the macrolevel, messages regarding women’s responsibility for their health are ubiquitous. At the microlevel, women must negotiate among competing messages and resources and a health care system that often confounds their efforts. These contradictions must be addressed before there are long-term effects on the health of midlife women.

Enhancing Public Input Into Decision Making: Development of the Calgary Regional Health Authority Public Participation Framework

Public participation in shaping policy and decisions that affect health is receiving increased attention. In the health sector, an imbalance exists between theory and practice. This article describes the development of a framework to promote public and community participation in one urban health authority, including the components of the public participation framework of purpose, values, guiding principles, and expected outcomes. A list of participation activities within the authority was obtained by survey. These activities are presented in relation to the conceptual framework. The article concludes with a se

Successful Integration and Maintenance of Screening for Domestic Violence in the Health Sector Moving Beyond Individual Responsibility

Domestic violence (DV) screening and prevention interventions have been implemented in the health sector; however, few health care settings have successfully implemented protocols that have been fully integrated and sustained within the larger organization. Researchers have tended to focus on individual-level characteristics of health care providers to explain this. The authors argue that organizational, structural, social, and cultural factors, especially related to gender, also play roles in adoption and integration of these interventions. It is important for policy analysts and program evaluators to use this larger framework to ensure sustainable integration of DV screening programs within health care systems.

Identifying Best Practices of Community Participation in Providing Services to Refugee Survivors of Torture: A Case Description

There is an increased interest in best practices in the design and implementation of specialized programs for refugee survivors of torture. The processes taking place in the development of such a program also warrant assessment. In particular, this paper addresses the importance of community participation. Using the Host Support Program for Survivors of Torture as a case study, we identify the community participation practices that emerged during stages of program development and describe how these practices have made possible a collaborative service delivery model and facilitated community capacity building that addresses the complex needs of refugee survivors of torture. The process of community collaboration is discussed as central to the process of effective community participation and organizing. The illustrated benefits of community participation position this model as a best practice.