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Health Promotion in Primary Healthcare Settings

Health Promotion in Primary Healthcare Settings. Dr. James Frankish, Senior Scholar Director, Institute of Health Promotion Research Associate Professor, Health Care & Epidemiology & College for Interdisciplinary Studies 3X MacDonald’s Employee-of-the-Month. IHPR

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Health Promotion in Primary Healthcare Settings

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  1. Health Promotion in Primary Healthcare Settings Dr. James Frankish, Senior Scholar Director, Institute of Health Promotion Research Associate Professor, Health Care & Epidemiology & College for Interdisciplinary Studies 3X MacDonald’s Employee-of-the-Month IHPR Institute of Health Promotion Research Partners in Community Heath Research-Training Program

  2. Research Team & Collaborators • IHPR: J. Frankish, G. Moulton, D. Gray, C. Cole, P. Stoesz • Co-Investigators: I. Rootman, B. Zumbo, D. Wilson, M. Hills, R. Lyons, M. Stewart • Advisory Committee: J. Besner, S. Bosca, D. Butler-Jones, M. Carr,P. McDonald, T. Mavor, G. Rentz,N. Whyte • Health Canada, Health TransitionFund, Canadian Consortium for Health Promotion Research

  3. Context & Rationale • Health promotion principles, practice & research have benefited Canada • Much of primary healthcare is gearedtoward community-centred health. Health promotion is in provincial/territorial mandates • Major reviews (Romanow, Mazankowski, Kirby) have noted that the health sector must towardhealth promotion. • Governments have a mandate topromote the health/quality of life of Canadians.

  4. A Continuum of Absurdities Primary Healthcare is Totally Responsible for Health Promotion There is No Role for Health Promotion in Primary Healthcare What is the Preferred Future for Health Promotion in Primary Healthcarein Canada?

  5. Canadian Principlesof Primary Healthcare • Patient involvement • Emphasis on keeping people healthy • Appropriate, high quality care • 24-hour access to care • Individual choice of provider • Ongoing patient-provider relationships • Clinical autonomy • Effective management • Affordability (Canadian Advisory Committee on Health Services)

  6. Methods • Literature Review • Preliminary Survey of primary healthcare Settings • Document Compilation & Review • IHPR-based Informants • Focus groups in Edmonton, Halifax, Toronto & Vancouver (45 participants) • Survey Questionnaire (web-based & hardcopy, sample of 523 primary healthcare sites) • 22 Semi-structured Interviews (Telephone)

  7. National Web-Based Survey • Background & Demographics • Fit of- Health Promotion Values- Process-Related Characteristics- Structural Characteristics- Activities-Related Characteristics- Outcomes-Related Characteristics • Intersectoral Collaboration for Health Promotion • Factors Limiting Engagement in Health Promotion • Reports of Data Collection re Health Promotion

  8. Types of Objects of Interest • Values • Process • Structure • Activities • Outcomes

  9. Example - Values of Health Promotion(% High Endorsement, > 6/7) • Adopting a broad view of health & its determinants 81% • Striving for optimal health/quality of life for staff/clients 91% • Empowering staff & clients 76% • Decreasing disparities for disadvantaged populations 70% • Sustaining human/natural resources for future 48% • Recognizing value/need for public participation in decisions about health & quality of life issues 75% • Integrating different views of health & quality of life 64% • Being accountable (to staff, clients & the public) 81%

  10. Example – “Process” Objects of Interest • Proactive Approach - planning 54%- implementation 42%- evaluation 55% • Individualization & Choice 54% • Mutual Learning 52% • Respectful Communication 93% • Meaningful Participation 64%

  11. Example – “Structural” Objects of Interest • Resource Allocation 75% • Committed Personnel 63% • Human Resources Development (Capacity Building) 51% • Intersectoral Collaboration 72% • Accessibility 58% • Accountability 45% • Governance & Decision-Making 48% • Communication Channels66% • Multidisciplinary Teams 65% • Organizational Culture 67%

  12. Example – “Outcome” Objects of Interest • Outcomes at the Individual (Client/Community) Level- Health status- Lifestyle and/or health behaviours- Health literacy- Quality of life & well-being • Outcomes at the Organizational Level- Health service effectiveness & efficiency- Quality of work environment- Accountability to clients & the public- Inclusion of stakeholders in planning, implementation,evaluation • Outcomes at the Community Level- Collaboration (within & across sectors)- Healthful public policy- Healthy environments (physical, economic & social)- Social action, social capital- Reduced health inequities

  13. Standards of Acceptability • The second component of a criterion is a "standard of acceptability." Objects of interest must be judged against some metric, scale or standard as to their success or failure. Standard are dictated by authority, custom or general consent. • Standards identify desired levels of outcomes & allow people to agree on how much should be achieved in return for the investment of resources. • Standards should reflect improvement in environmental, behavioral, social, economic, health educational or policy, organizational conditions. Standards apply to program quality & outcomes.

  14. “Actual needs” Public’s perceived needs, priorities A Resources, feasibilities, policy Three Worlds of Planning Historical, Scientific, Normative Standards Arbitrary, Experiential, Community, Utility Standards Propriety, Feasibility Standards From Green & Kreuter, 1991; Judd, Frankish & Moulton, 2001

  15. Next Steps & Development of Resources • Reduce Number of Core Characteristics & Pick Indicators for Each • Identification of Partner Demonstration Sites • Identification of Common & Site-Specific Indicators • Funding & creation of adequate data collection infrastructure • Collection of data based on core characteristics & indicators • Consideration of working indicators against standards

  16. Contact Information Dr. Jim Frankish, Senior Scholar, Michael Smith Foundation Institute of Health Promotion Research Rm 425, Library Processing Centre 2206 East Mall Vancouver BC V6T 1Z3 604-822-9205, 822-9210, frankish@interchange.ubc.ca Personal Website: jimfrankish.com BC Homelessness & Health Research – Network bchhrn.ihpr.ubc.ca BC Homelessness Virtual Library - www.hvl.ihpr.ubc.ca Partners in Community Health Research www.pchr.net

  17. References • 2007. Frankish J, Moulton G, Quantz D, Carson A, Casebeer A, Eyles J, Labonte R, Evoy B. Addressing the non-medical determinants of health: A survey of Canada’s health regions. Canadian Journal of Public Health, 98(1):41-47. • 2006. Frankish J, Moulton G, Rootman I, Cole C, Gray D. Setting a Foundation ‑ Values & Structures as a Foundation for Health Promotion in Primary Health Care. Primary Health Care Research & Development, 7 (2), 172-182. • 2006. Moulton G, Frankish J, Rootman I, Cole C, Gray, D. Building a Foundation: Strategies, Processes & Outcomes of Health Promotion in Primary Health Care Settings, 7 (3), 269-277.

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