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Searching for ‘Best’ Practices in Aboriginal Health Programming & Service Delivery in Alberta. Marcy Burka-Charles, MSc Calgary Health Region. Acknowledgement. This geographic area to be the traditional territory of the Mi’kmaq people from… Mainland Nova Scotia Cape Breton Island.
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Searching for ‘Best’ Practices in Aboriginal Health Programming & Service Delivery in Alberta Marcy Burka-Charles, MSc Calgary Health Region
Acknowledgement This geographic area to be the traditional territory of the Mi’kmaq people from… • Mainland Nova Scotia • Cape Breton Island
Overview • Background • Project Activities • Evaluation Methodology • Key Results
Background • Partners: • 6 Regional Health Authorities (RHAs) • Steering Committee: • RHA representatives • Govern project activities • Provincially Funded: • Aboriginal Health Strategy Project Fund
cont. Background • Objectives: • Establish a base-line inventory of ‘best’ practices • Assess ‘effectiveness’ of RHA funded projects (1999 – 2005) • Significance: • Future funding models • Future research agenda
Project Activities • Inventory • Literature Review • ‘Best’ practice…. • n = 100 periodicals & non-periodicals • No universal definition • a strategy, activity, approach, or program found to be effective through research, evaluation, &/or experience • Models reviewed were primarily euro-centric & concentric. Most published models omitted culture & spirituality as ‘best’ practice attributes • n = 82 (1999 - 2005) • community health initiatives • Model Consensus
Better Practice Model • Three-phase model • Incorporates Indigenous & Western health ideologies • Synthesizes evidence from both research & practice • Flexible Source: Cameron et al (2001).
Evaluation Methodology • Scope of Review • Broad • Subjects: Aboriginal Albertans • Data Sources • Literature Review • Document Review • Focus Group Interviews (FGIs) • Analysis • Better Practice Criteria (3 categories) • Thematic Analysis • Recommendations • Practice • Research
Model Modifications Data Sources Literature Review Document Review FGIs • Effectiveness Criteria: assess selection bias, study design, blinding, confounders, data collection methods, non- responders, etc. • Limitations: • Scope of review too broad • Solution: • extract examples of better practices from document review • apply criteria to future literature review • Plausibility Criteria: assesses program/service potential vs. effectiveness • Practicality Criteria: assesses affordability, availability, & compatibility • Attributes applied = 16 • Limitations: • Report gathering was challenging (18/82) • no information on need, synergy, sustainability, etc. • Solution: • Draft FGI questions • Plausibility Criteria: questions posed to fulfill information gap from document review (Q 1-4) • Purposeful Sampling:questions posed (Q 5-6)… • What is a ‘best’ or ‘better’ practice? • What facilitates it? • What hinders it? • Face Validity Check: • Stage 1: Respondents • Stage 2: St. Committee
Key Results – Document Review A)Recommended & Promising Practices • Develop cohesive partnerships • Hire Aboriginal Health Liaisons & Case Workers • Incorporate Indigenous language & traditions • Evaluation B) ‘To be tracked’ Practices • Hiring protocols • Placement of Aboriginal health programs in RHAs
cont. Key Results - FGIs A ‘better’ practice… • Collaboration • Education • Paradigm shift • Research
cont. Key Results - FGIs Facilitators to a ‘better’ practice… • Formal agreements • Theoretical approach • Health system changes • Champions
cont. Key Results Barriers to a ‘better’ practice… • Inaccurate health statistics • Institutional culture • Politics • Multi-level deficits
cont. Key Results Multi-level deficits included… • Lack of… • Common vision, mission, goals • Human resources • Fiscal resources • Time • Cultural competence & safety
Additional Acknowledgements • Funding Organization • Alberta Health & Wellness, Alberta Government • Steering Committee & Co-Authors • Phillip Burke (Alberta Health & Wellness) • Lorraine Deschambeau (Aspen Health Region) • Brett Hodson (Calgary Health Region) • Malcolm King (ACADRE, University of Alberta) • Barb Olsen & Tracy Lee (David Thompson Health Region) • Keltie Paul (Northern Lights Health Region) • Karoline Phillip (Chinook Health Region) • Adrienne Wiebe (Capital Health Region)
