Health Promotion Health Promotion in Primary Healthcare Settingsin Primary Healthcare Settings

Dr. James Frankish, Senior ScholarDirector, Institute of Health Promotion ResearchAssociate Professor, Health Care & Epidemiology

& College for Interdisciplinary Studies

3X MacDonald’s Employee-of-the-Month

Partners in Community Heath

Research-Training Program

IHPR Institute of Health Promotion Research

Research Team & CollaboratorsResearch 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

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.

A Continuum of Absurdities

Primary Healthcare is Primary Healthcare is Totally ResponsibleTotally Responsible for for Health PromotionHealth Promotion

There is There is No RoleNo Role for Health for Health Promotion in Primary Promotion in Primary HealthcareHealthcare

What is the What is the Preferred Preferred FutureFuture f for Health or Health

Promotion in Primary Promotion in Primary HealthcareHealthcarein Canada?in Canada?

Canadian PrinciplesCanadian Principlesof Primary Healthcareof 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)

MethodsMethods 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)

National Web-Based SurveyNational 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

Types of Objects of InterestTypes of Objects of Interest

Values

Process

Structure

Activities

Outcomes

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%

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%

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 Channels 66% Multidisciplinary Teams 65% Organizational Culture 67%

Example – “Outcome” Objects of InterestExample – “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

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.

““ActualActualneeds”needs”

Public’sPublic’sperceived needs,perceived needs,

prioritiespriorities

Resources,Resources,feasibilities,feasibilities,

policypolicy

AA

Three Worlds of Planning

From Green & Kreuter, 1991; Judd, Frankish & Moulton, 2001

Arbitrary, Experiential,Community, Utility Standards

Historical, Scientific, Normative Standards

Propriety, FeasibilityStandards

Next Steps & Development of ResourcesNext 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

Contact InformationContact Information

Dr. Jim Frankish, Senior Scholar, Michael Smith FoundationInstitute of Health Promotion ResearchRm 425, Library Processing Centre2206 East Mall Vancouver BC V6T 1Z3604-822-9205, 822-9210, frankish@interchange.ubc.caPersonal Website: jimfrankish.comBC Homelessness & Health Research – Network bchhrn.ihpr.ubc.caBC Homelessness Virtual Library - www.hvl.ihpr.ubc.caPartners in Community Health Research www.pchr.net

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.