Biomedical subjects

Wilfreda E Thurston

Publications and source records attributed to Wilfreda E Thurston.

18 recordsLinked to original sources

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

Representation strategies in public participation in health policy: the Aboriginal Community Health Council.

Within Canada's Aboriginal population, an ongoing health promotion strategy has been the facilitation of community participation in the development and application of health policy. The Calgary Health Region's Aboriginal Community Health Council has provided a setting for involving the local Aboriginal population in health policy and program development for over a decade. This paper represents the results of a case study to identify the Council's strategies for this work. Data sources included documents, such as meeting minutes and other reports; key informant interviews with past and present Council members and health region representatives; and participant observation of Council functions. Although direct membership in the Council provided a core approach for representing the community, other strategies were actively utilized to involve the public. These included building links and partnerships with community organizations, networking, consultation activities and the identification of special needs groups.

Canada↗

PubMed2006

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.

Domestic Violence↗

PubMed2006

Women's health resources: facilitating a community of care for midlife women.

Since 1981 research has explored the role of women's health centres in providing health information and education to women in a non-traditional setting. These settings have been designed to provide more appropriate, and often more comprehensive, care by responding to the specific health issues and needs of women across the age continuum. The type of care and resources provided by these centres make a significant contribution to women's capacity for participation in decisions and action around their own, health. This article examines the service delivery and perceived roles of one such centre, the Women's Health Resources (WHR) centre in Calgary, Canada. Data for this paper were extracted from WHR evaluation forms for 199 midlife women seeking individual consultation, as well as personal interviews that were conducted with four female staff members. Clients of the WHR cited numerous reasons for seeking service at the centre, the most common being for emotional health care, nutritional consultation or more comprehensive information on a specific illness. Three major components of service provision at the centre were identified: information, psychological care and complementarity of services. Women used the information they gained from WHR services to aid in health decision-making and as a resource for empowerment in being partners in their own health. Clients noted that the WHR was a valuable source of additional information beyond what their own family physician and/or specialist were able to provide. The feminist and woman-centred care at WHR, in conjunction with the emphasis on education, offers an invaluable source of information and services for women. Through the shared experiences of both the clients and staff of this centre, this article provides an outline of how such services are perceived and utilized.

Alberta↗

PubMed2006

Prevalence of violence against women reported in a rural health region.

INTRODUCTION: Violence against women in Canada is an important public health problem. Published research that reports prevalence of violence against women by province or region is limited, and estimates of the rates of violence experienced by rural women are sparse. METHODS: This study reports the results of a secondary analysis of data to examine the prevalence of physical and sexual assault reported by women in a rural health region in Alberta, Canada. The report of assault was then examined to determine its relationship to self-reported health conditions, behaviours and health service use. RESULTS: In this study, 5% of women reported experiencing physical assault in the last 12 months and 23% reported experiencing sexual assault in their lifetime. Younger women reported more assault than older women. Women who reported sexual assault were more likely to report having used illicit drugs. Women who reported physical assault within the last 12 months were significantly more likely to also report having accessed mental health services and emergency services within the past year. Most women had seen a general practitioner or family doctor within the last 12 months. CONCLUSION: We argue that an integrated community-based model of service that includes the health sector is necessary to address violence against women in rural areas.

Adolescent↗

PubMed2005

A case study of volunteers providing labour and childbirth support in hospitals in Canada.

OBJECTIVE: to document the process and outcome of an attempt to combine and institutionalise two grassroots health programmes that provided trained volunteers to support women through labour and childbirth in hospital. DESIGN: a qualitative, descriptive, comparative case study of programmes, with data collected through in-depth individual interviews with key informants and document review. SETTING: a Regional Health Authority in Canada. PARTICIPANTS: 16 women, from various stakeholder groups, with knowledge about the programmes. FINDINGS: despite considerable effort expended, the unified regional programme was not realised. This research highlights contextual factors that were salient for the programme's implementation. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: complex individual, interpersonal and institutional factors needed to be acknowledged but were not addressed in programme planning. This research may be relevant to policy and decision makers considering expansion of grassroots or community programmes to regional levels of service.

Adult↗

PubMed2005

The farm as a setting for health promotion: results of a needs assessment in South Central Alberta.

Farming is acknowledged to be a dangerous occupation that poses risks for farmers, farm employees and family members. This paper explores the farm as a setting where health promotion and prevention programs can be implemented. We present data from an occupational health and safety needs assessment of 347 farms in the South Central region of the province of Alberta, Canada. The data are used to describe farmers' familiarity with farm living, thoughts on farm safety, the numbers of people working and types of work performed, other work, income, and the availability of resources. Results are discussed in terms of implications for practitioners under three proposed justifications for a settings model. Data revealed that there is so much heterogeneity among these farms that an ecological settings approach to program development that accounts for both the composition and context of rural settings is more appropriate than the settings model currently in use.

Adult↗

PubMed2005

Public participation for women's health: strange bedfellows or partners in a cause?

A major focus of health system reform in Canada has been the regionalization of health services administration. With a goal of bringing decision-making closer to the community, there has been a commitment to public participation in planning by some health authorities. Women, however, often feel that their participation is minimal or their needs are not addressed. During regionalization of the Alberta health system, the Calgary Health Region (CHR) negotiated an agreement with the Salvation Army to provide women's health services through the Grace Women's Health Centre, a major part of the region's women's health program. We present a case study exploring the process and final agreement and the impact of this agreement on women's participation in health policy development. The historical context and the nature and impact of the agreement are described and several participation strategies that occurred within the partnership are discussed. The development of a formal partnership agreement, a governance model, was a success for public participation in this case; however, the greatest success for women was maintenance of a political space in which women's health as a priority could be discussed in a context where the forces against gender equity talk are strong.

Alberta↗

PubMed2005

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. DESIGN: Qualitative research methods, following the grounded theory tradition, were used to develop a conceptual framework that described the dimensions of the concept of family-centred care and their interrelationships, in the substantive area of children's developmental services. This article reports on and extends key findings from this grounded theory study, in light of current trends in the literature. SETTING AND PARTICIPANTS: The substantive area that served as the setting for the research was developmental services at a children's hospital in Alberta, Canada. Data was collected through focus groups and individual interviews with 37 parents of children diagnosed with a developmental problem and 16 frontline health-care providers. FINDINGS: Key findings from this research project do not support the current emphasis in family-centred care research and practice on conceptualizing family-centred care as the shifting of care, care management, and advocacy responsibilities to families. Rather, what emerged was that parents want to work truly collaboratively with health-care providers in making treatment decisions and on implementing a dynamic care plan that will work best for child and family. DISCUSSION AND CONCLUSIONS: A definition of collaboration is provided, and the nature of collaborative relationships described. Contributing factors to the difficulty in establishing true collaborative relationships between families and health-care professionals, where the respective roles to be played by health-care professionals and families are jointly determined, are discussed. In light of these findings we strongly advocate for the re-examination of current family-centred care policy and practice.

Adult↗

PubMed2005

The role of the media in public participation: framing and leading.

This article focuses on the framing of women's health services in the context of restructuring dictated by health system regionalization. By examining the archives of a local newspaper and the minutes and documents of one of the key organizations involved in restructuring after regionalization, it was possible to examine the public discourse of the time and subsequently the journalists' and the readerships' understandings of women's health. The evidence suggests that the Salvation Army was instrumental in setting the tone that was taken by the media in framing the issues around the closure and move of its Grace Women's Health Centre. While the Calgary Health Region was successful in bringing the Grace under its mandate and organizational control, it was the Salvation Army, with its highly visible and powerful fundraising arm and its advocacy for holistic women's health that caught the public's attention. The internal discourse tracked some of the emerging issues, known only to those involved at managerial levels within the health system, but the public discourse kept women centered in decisions regarding the partnership. Women from many constituencies must continue to participate in the public policy realm to ensure that women's health remains an issue in health reform.

Alberta↗

PubMed2004

Public participation in regional health policy: a theoretical framework.

How best to involve the public in local health policy development and decision-making is an ongoing challenge for health systems. In the current literature on this topic, there is discussion of the lack of rigorous evaluations upon which to draw generalizable conclusions about what public participation methods work best and for what kinds of outcomes. We believe that for evaluation research on public participation to build generalizable claims, some consistency in theoretical framework is needed. A major objective of the research reported on here was to develop such a theoretical framework for understanding public participation in the context of regionalized health governance. The overall research design followed the grounded theory tradition, and included five case studies of public participation initiatives in an urban regional health authority in Canada, as well as a postal survey of community organizations. This particular article describes the theoretical framework developed, with an emphasis on explaining the following major components of the framework: public participation initiatives as a process; policy making processes with a health region; social context as symbolic and political institutions; policy communities; and health of the population as the ultimate outcome of public participation. We believe that this framework is a good beginning to making more explicit the factors that may be considered when evaluating both the processes and outcomes of public participation in health policy development.

Canada↗

PubMed2004

Embodied minds, restless spirits: mid-life rural women speak of their health.

This manuscript explores mid-life women's views of corporeality and the links that these have to their health. Using ethnographic interview techniques, community based interviewers talked with 24 women from rural settings. Our findings suggest that mid-life women have an embodied view of their minds and spirits, and that dualism is generally reserved for thinking about and interacting with the biomedical system. They have a sense of themselves as unique individuals who have a large role in caregiving, multiple other roles, and have luck but also agency in and control of their health and well-being. Motion was a strong theme throughout the interviews. Women embraced this mobility as a characteristic of their well-being as they coped with multiple changes associated with mid-life. In contrast to what some philosophers maintain, women seem to partner both corporeal changes and metaphor. While the sample was limited in scope, the findings support the importance to women's health of understanding the intersections between compositional and contextual variables in various settings.

Adult↗

PubMed2003

Development and testing of a framework for assessing the effectiveness of health promotion.

OBJECTIVES: The purpose was to develop and test a framework for assessing the overall effectiveness of health promotion in one Canadian province. METHODS: The project relied on expert opinion and consensus. A multidisciplinary team developed a Project Description Framework and a Health Promotion Evaluation Framework. Two sets of inclusion criteria were developed for selecting projects to be assessed using the Framework. The sampling frame was all health promotion projects starting in Alberta in January 1993 or later for which a written program evaluation could be obtained. Of 180 project reports, 91 met the first set and 35 met the remaining inclusion criteria. Two research associates independently used the Project Description Framework. Three associates independently applied the inclusion criteria. Consensus was reached in all cases. Research team members used the Health Promotion Evaluation Framework to assess the 35 projects and to comment on its utility and any gaps identified. RESULTS: A framework for assessing the effectiveness of health promotion was developed and tested. CONCLUSION: This framework is a useful tool as evidenced by the review that was obtained and subsequent applications.

Alberta↗

PubMed2003

Theory and models for planning and evaluating institutional influenza prevention and control programs.

BACKGROUND: Low rates of staff influenza vaccine coverage occur in many health care facilities. Many programs do not offer vaccination to physicians or to volunteers, and some programs do not measure coverage or do so only for a subset of staff. The use of theory in planning and evaluation may prevent these problems and lead to more effective programs. METHOD: We discuss the use of theory in the planning and evaluation of health programs and demonstrate how it can be used for the evaluation and planning of a hospital or nursing home influenza control program. RESULTS: The application of theory required explicit statement of the goals of the program and examination of the assumptions underlying potential program activities. This indicated that staff should probably be considered as employees, volunteers, physicians, and contractors of the facility. It also directed attention to evidence-based strategies for increasing vaccination rates. CONCLUSION: The application of a program planning model to a problem of institutional influenza prevention may prevent planners from excluding important target populations and failing to monitor the important indicators of program success.

Canada↗

PubMed2003

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.

Alberta↗

PubMed2003

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.

Alberta↗

PubMed2003

Ethical review of health promotion program evaluation proposals.

Some policies state that program evaluation falls within the domain of administrative research that does not require review by an ethics review board. We propose that some health promotion program evaluations include at least one element of research and can be distinguished from quality assurance. Although American and Canadian evaluation societies provide important guidelines and standards for evaluation practitioners, processes for accountability to the public are provided by research ethics boards. The field of health promotion is, by its nature, replete with challenges to existing research ethics boards. Given the dearth of published literature on the ethics of health promotion evaluation or practice, the field could benefit from the open debate that reviews of proposals would encourage.

Canada↗

PubMed2003

Constraints on women's intersectoral health partnerships: lessons from Canada.

Issues that constrain women's organizations from developing partnerships that promote women's health through health policy development and implementation are discussed in terms of lessons drawn from 3 studies. Key issues are the values underlying notions of partnership and participation, communication across sectors, different worldviews, and the resource limitations of feminist organizations. By attending to constraints and learning from successes and failures, women's organizations will be able to promote women's health through intersectoral partnering. The health sector and health professionals need to respond to the constraints in order to benefit from the expertise that resides within women's organizations.

Canada↗