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Biomedical subjects

Penelope Hawe

Publications and source records attributed to Penelope Hawe.

At least 19 recordsLinked to original sources
PubMed2006

The costs of a community-based intervention to promote maternal health.

The costs of community-level interventions are rarely reported, although such insights are needed if intervention research is to be useful to practitioners seeking to understand what might be involved in replicating interventions in different contexts. We report the costs of a 2-year community-based intervention to promote the health of recent mothers in Victoria, Australia. Program of Resources, Information and Support for Mothers was an integrated programme of primary care and community-based strategies. It had health care professional training, health education and community development components as well as an emphasis on creating 'mother-friendly' environments. Costs included the programme costs [primarily the salaries of the community development officers (CDO) in the field] and also 'induced' costs that relate to the CDOs' successes in attracting additional resources to the intervention from the local community. The total cost averaged A$272,490 per rural community and A$313,900 per urban community, equivalent to A$172.40 and A$128.70 per mother, respectively. For every A$10 of public funds initially invested in the project, the CDOs were able to attract a further A$1-2 worth of local resources, predominantly in the form of volunteer time or donated services.

Australia↗
PubMed2006

What maintains parental support for vaccination when challenged by anti-vaccination messages? A qualitative study.

This study sought to explore how parents respond to competing media messages about vaccine safety. Six focus groups with mothers of infants were shown television vignettes of typical pro- and anti-vaccination claims. Thematic analysis of transcripts was undertaken. Mothers expressed surprise and concern about alleged vaccine risks but quickly reinstated their support for vaccination by deference to authority figures; type-casting immunisation opponents; and notions of anticipatory regret, good parenting and social responsibility. We conclude that personal experiences, value systems and level of trust in health professionals are fundamental to parental decision making about vaccination. Vaccination advocacy should increase the focus on matters of process such as maintaining trust and public confidence, particularly in health professionals. Stories about people affected by vaccine-preventable diseases need to re-enter the public discourse.

Adult↗
PubMed2006

Understanding place and health: a heuristic for using administrative data.

The increasing availability, use and limitations of administrative data for place-based population health research, and a lack of theory development, created the context for the current paper. We developed a heuristic to interrogate administrative data sets and to help us develop explanatory pathways for linking place and health. Guided by a worked example, we argue that some items in administrative data sets lend themselves to multiple theories, creating problems of inference owing to the implications of using inductive versus deductive reasoning during the research process, and that certain types of theories are privileged when used administrative data bases.

Canada↗
PubMed2006

Test-retest reliability of willingness to pay.

We describe the results of a survey designed to assess the test-retest reliability of a method of establishing willingness to pay. Willingness to pay values for a hypothetical intervention were elicited from a randomly selected, population sample by face-to-face interview on three occasions over a period of 5 weeks. Test-retest reliability was assessed by intraclass correlation and by generalizability analysis. Reliability was acceptable but not substantial, and there was a statistically significant shift in mean value between first and second assessments. The greatest source of variation in values was the participants. There was also a substantial interaction between time and participants, suggesting that some respondents changed their answers at follow-up. The results were sensitive to the high valuations provided by four of the participants, however.

Australia↗
PubMed2005

The privileging of communitarian ideas: citation practices and the translation of social capital into public health research.

The growing use of social science constructs in public health invites reflection on how public health researchers translate, that is, appropriate and reshape, constructs from the social sciences. To assess how 1 recently popular construct has been translated into public health research, we conducted a citation network and content analysis of public health articles on the topic of social capital. The analyses document empirically how public health researchers have privileged communitarian definitions of social capital and marginalized network definitions in their citation practices. Such practices limit the way public health researchers measure social capital's effects on health. The application of social science constructs requires that public health scholars be sensitive to how their own citation habits shape research and knowledge.

Health Services Research↗
PubMed2005

Ecological theory in practice: illustrations from a community-based intervention to promote the health of recent mothers.

We present a qualitative case study where we used four principles of ecological theory from community psychology as a template to assess the dynamics about how a preventive community intervention was transacted in eight communities in Victoria, Australia. The principles were cycling of resources, interdependence, adaptation, and succession. Ecological thinking focuses on key resources in communities. That is, the people, events, and settings that are the foundations of thinking about communities as systems. The data set consists of field diaries kept by and serial interviews with nine community development workers over a 2-year period. We found that the analysis highlighted a process-oriented way of representing the intervention, one that sees beyond the intervention's technical components (or packaged elements) to the complexities of the cultural and political change processes occurring beneath. The value of this is the attention focussed on likely project sustainability.

Community Networks↗
PubMed2005

Introducing a means of quantifying community reputation: the print media as a data source.

A community's reputation may have implications for self-esteem, morale, or other health outcomes of residents. In this study, we introduce a means of quantifying the reputation of communities in Calgary, Canada based on their portrayal in the daily citywide newspaper. Publication dates were selected from an 8.5-year period using constructed week sampling. For communities designated as high or low in well-being, sampled references were rated as positive, negative, or neutral in topic, by two independent raters who were blind to community identity. Findings suggest that the print media represent a convenient and discriminating data source for characterising some aspects of community reputation.

British Columbia↗
PubMed2005

Individual-level and neighborhood-level income measures: agreement and association with outcomes in a cardiac disease cohort.

BACKGROUND: Census-based measures of income often are used as proxies for individual-level income. Yet, the validity of such area-based measures relative to 'true' individual-level income has not been fully characterized. OBJECTIVES: The objectives of this study were (1) to determine whether area-based measures of household income are a suitable proxy for self-reported household income and (2) to assess whether these measures are associated with outcomes in a cardiac disease cohort. RESEARCH DESIGN: We used a prospective cohort from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) cardiac catheterization registry. SUBJECTS: A total of 4372 patients having undergone cardiac catheterization and who also completed a 1-year follow-up questionnaire on self-reported income level were studied. MEASURES: Our measurements were survival to 2.5 years after catheterization and health-related quality of life (EuroQoL). RESULTS: Agreement between the 2 income measures generally was poor (unweighted Kappa = 0.07), particularly for the low-income patients. Despite this poor agreement, both income measures were positively associated with survival and EuroQoL scores. An outcome analysis that simultaneously considered individual level income and area-based income revealed that low-income individuals have poorer survival and lower quality of life scores if they live in low income neighborhoods, but not if they live in high income neighborhoods. CONCLUSIONS: The area-based estimates of household income in these data demonstrate poor agreement with self-reported household income at the level of individual patients, particularly for low-income patients. Despite this, both income measures appear to be prognostically relevant, perhaps because individual and neighborhood income measure different constructs.

Alberta↗
PubMed2005

Ecological perspectives in health research.

An ecological perspective on health emphasises both individual and contextual systems and the interdependent relations between the two. Origins of this approach have emanated from multiple disciplines over the past century or more. This article provides a glossary of perspectives, processes, and settings that pertain to an ecological approach in health research.

Ecology↗
PubMed2005

Contested ground: how should qualitative evidence inform the conduct of a community intervention trial?

This paper presents issues which arose in the conduct of qualitative evaluation research within a cluster-randomized, community-level, preventive intervention trial. The research involved the collection of narratives of practice regarding the intervention by community development officers working in eight communities over a two-year period. The community development officers were largely responsible for implementing the intervention. We discuss the challenges associated with the collection of data as the intervention unfolded, in particular, the disputes over cues to revise and adjust the intervention (i.e. to use the early data formatively). We explore the ethical uncertainties that arise when multiple parties have different views on the legitimacy of types of knowledge and the appropriate role of research and theory in various trial stages. These issues are discussed drawing on the fields of ethnography, community psychology, epidemiology, qualitative methodology and notions of research reflexivity. We conclude by arguing that, in addition to the usual practice of having an outcome data-monitoring committee, community intervention trials also require a process data-monitoring committee as a forum for debate and decision-making. Without such a forum, the relevance, ethics and position of qualitative evaluation research within randomized controlled trials are destined to be a point of contention rather than a source of insight.

Cluster Analysis↗
PubMed2004

Researching practice: the methodological case for narrative inquiry.

Research interest in the analysis of stories has increased as researchers in many disciplines endeavor to see the world through the eyes of others. We make the methodological case for narrative inquiry as a unique means to get inside the world of health promotion practice. We demonstrate how this form of inquiry may reveal what practitioners value most in and through their practice, and the indigenous theory or the cause-and-consequence thinking that governs their actions. Our examples draw on a unique data set, i.e. 2 two years' of diaries being kept by community development officers in eight communities engaged in a primary care and community development intervention to reduce postnatal depression and promote the physical health of recent mothers. Narrative inquiry examines the way a story is told by considering the positioning of the actor/storyteller, the endpoints, the supporting cast, the sequencing and the tension created by the revelation of some events, in preference to others. Narrative methods may provide special insights into the complexity of community intervention implementation over and above more familiar research methods.

Community Networks↗
PubMed2004

A census of economic evaluations in health promotion.

While policy makers argue for a greater share of health resources to go to health promotion, action is stalled by, among other things, the perception that little is known about which interventions offer the best health returns. Additionally, what is missing is any sense of what the economic literature in health promotion looks like overall. Where is the economic evidence plentiful and where is it scant? The project described here compiled a census of economic evaluations in health promotion. Studies were classified according to a four-part typology that documented the strategic intent of the intervention, the risk factor being addressed, the population most affected and the setting in which the intervention took place. Since 1990, there have been over 400 economic evaluations of health-promoting interventions in the peer review and grey literatures. Of these, 90% address biological or behavioral determinants of health. Relatively little is known about the economics of population health advocacy or interventions to tackle the social and economic determinants of health. Initiatives are in place to increase the availability of economic evidence. Research is also needed into how to support decision makers' use of imperfect, incomplete and uncertain information.

Cost-Benefit Analysis↗
PubMed2004

A glossary for evidence based public health.

This glossary seeks to define and explain some of the main concepts underpinning evidence based public health. It draws on the published literature, experience gained over several years analysis of the topic, and discussions with public health colleagues, including researchers, practitioners, policy makers, and students.

Evidence-Based Medicine↗
PubMed2004

Methods for exploring implementation variation and local context within a cluster randomised community intervention trial.

Insignificant or modest findings in intervention trials may be attributable to poorly designed or theorised interventions, poorly implemented interventions, or inadequate evaluation methods. The pre-existing context may also account for the effects observed. A combination of qualitative and quantitative methods is outlined that will permit the determination of how context level factors might modify intervention effectiveness, within a cluster randomised community intervention trial to promote the health of mothers with new babies. The methods include written and oral narratives, key informant interviews, impact logs, and inter-organisational network analyses. Context level factors, which may affect intervention uptake, success, and sustainability are the density of inter-organisational ties within communities at the start of the intervention, the centrality of the primary care agencies expected to take a lead with the intervention, the extent of context-level adaptation of the intervention, and the amount of local resources contributed by the participating agencies. Investigation of how intervention effects are modified by context is a new methodological frontier in community intervention trial research.

Community Health Services↗
PubMed2003

Reliability of health utility measures and a test of values clarification.

This study examines the test-retest reliability of two methods of establishing health preference weights and assesses the effectiveness of a brief values-clarification exercise. Survey participants were randomly allocated to one of two groups and received either a standard protocol for eliciting health preferences (comparison group) or an augmented protocol designed to encourage reflection and deliberation (intervention group). Preferences were elicited on three occasions over 5 weeks. The results show that the two valuation methods each had acceptable levels of test-retest reliability. No significant differences were found in preference weights over time or between intervention and comparison groups. The values-clarification exercise had some impact on individual answers, but the changes cancelled each other out at the group level. There was no discernable intervention effect at the group level. It is premature to draw conclusions from one study about why, or even how, a person's valuations might change over time, but our results support the use of current valuation techniques for group-level analyses.

Attitude to Health↗
PubMed2003

Solutions forgone? How health professionals frame the problem of postnatal depression.

Our interest is in how particular solutions in postnatal depression have a tendency to be adopted at the expense of alternative solutions. One aspect of the answer may lie in how people in positions of authority think about problems. 'Framing' refers to the way particular causalities, consequences and moralities are contained within the ways in which people communicate concepts, in particular in language and in metaphor. Naming the way problems are framed and identifying alternative frames, (i.e., 'reframing') may provide an opportunity to set problems more effectively and to identify solutions that will solve the problem more effectively. A framing analysis was conducted, drawing on interviews with senior researchers, policy makers and practitioners in the field of postnatal depression. Seven principal ways in which the problem of postnatal depression was framed were illuminated. These fitted into three broad approaches to the problem: individual therapeutic approaches, social competence approaches and societal approaches. Participants in our study were comfortable and articulate in describing the problem of postnatal depression-whether they were focused on the individual or societal levels of analysis. However, they were less well versed and comfortable in discussing what they felt might be important social or societal-level solutions, lacking in both language and schema to do so. The history and hierarchy that is carried by people from the helping professions may be hindering new avenues to help mothers with new babies.

Adaptation, Psychological↗