Public health leadership: Competencies to guide practice.

In 2013, the Community Health Nurses of Canada in partnership with the Canadian Institute of Public Health Inspectors and the Manitoba Public Health Managers Network received funding from the Public Health Agency of Canada to develop a set of interdisciplinary leadership competencies for seven public health disciplines. The Leadership Competencies for Public Health Practice in Canada project comprised a multimethod research approach that included a scoping literature review, on-line survey, webinar-based focus groups, and a modified Delphi process. The 49 leadership competencies for public health practice were organized according to the LEADS Canada capabilities. The leadership competencies extend the core public health competencies and discipline-specific competencies and reflect foundational values of public health. The leadership competencies can be applied to professional development pathways, mentoring programs, and performance appraisals to advance public health practice. How these competencies have been enacted by public health leaders during the COVID-19 pandemic is discussed.

Designing a framework for primary health care research in Canada: a scoping literature review.

BACKGROUND: Despite significant investments to improve primary health care (PHC) delivery in Canada, provincial health care systems remain fragmented and uncoordinated. Canada's commitment to strengthening PHC should be driven by robust research and evaluation that reflects our health policy priorities and responds to the needs of the population. One challenge facing health services researchers is developing and sustaining meaningful research priorities and agendas in an overburdened, complex health care system with limited capacity for PHC research and support for clinician researchers. METHODS: A scoping review of the literature was conducted to examine PHC research priorities in Canada. We compared national research priorities for PHC to research priorities being considered in the province of Alberta. Our scoping review was guided by the following questions: (1) What are the research priorities for PHC in Canada?; and (2) What process is used to identity PHC research priorities? RESULTS: Six key theme areas for consideration in setting a PHC research agenda were identified: research in practice, research on practice, research about practice, methods of priority setting, infrastructure, and the intersection of PHC and population/public health. These thematic areas provide a new framework for guiding PHC research in Canada. It was developed to generate best practices and new knowledge (i.e., innovation), transform PHC clinical practice or support quality improvement (i.e., spread), and lead to large-scale health care system transformation (i.e., scale). CONCLUSIONS: Priority-driven research aims to answer questions of key importance that are likely to have a significant impact on knowledge or practice in the short to medium term. Setting PHC research priorities ensures funded research has the greatest potential population health benefit, that research funding and outputs are aligned with the needs of practitioners and decision makers, and that there is efficient and equitable use of limited resources with less duplication of research effort. Our findings also suggest that a common research priority framework for PHC research in Canada would ensure that research priority-setting exercises are grounded in an evidence-based process.

Risk factors for positional plagiocephaly and appropriate time frames for prevention messaging.

OBJECTIVE: To determine potential risk factors for developing positional plagiocephaly in infants seven to 12 weeks of age in Calgary, Alberta. METHODS: A prospective cohort design was used. Healthy term infants (n=440), seven to 12 weeks of age, from well-child clinics at four community health centres in Calgary, Alberta were assessed by the primary author and a registered nurse research assistant using Argenta's plagiocephaly assessment tool. Parents completed a questionnaire surveying risk factors. RESULTS: The incidence of positional plagiocephaly was estimated to be 46.6%. The following risk factors were identified using multiple logistic regression: right-sided head positional preference (OR 4.66 [95% CI 2.85 to 7.58]; P<0.001), left-sided head positional preference (OR 4.21 [95% CI 2.45 to 7.25]; P<0.001), supine sleep position (OR 2.67 [95% CI 1.58 to 4.51]; P<0.001), vacuum/forceps assisted delivery (OR 1.88 [95% CI 1.02 to 3.49]; P=0.04) and male sex (OR 1.55 [95% CI 1.00 to 2.38]; P=0.05). CONCLUSION: Advice to vary infants' head positions needs to be communicated to parents/guardians well before the two-month well-child clinic visit. This could occur in the prenatal period by prenatal care providers or educators, or during the neonatal period by postpartum and public health nurses. Prevention education may be emphasized for parents/guardians of male infants and infants who have had assisted deliveries.

OBJECTIF: Déterminer les facteurs de risque potentiels de plagiocéphalie positionnelle chez les nourrissons de sept à 12 semaines à Calgary, en Alberta. MÉTHODOLOGIE: Dans une cohorte prospective, des nourrissons à terme et en santé (n=440) de sept à 12 semaines provenant de cliniques d'enfants en santé de quatre centres de santé communautaire de Calgary, en Alberta, ont été évalués par l'auteur principal et une infirmière adjointe à la recherche au moyen de l'outil d'évaluation de la plagiocéphalie d'Argenta. Les parents ont rempli un questionnaire pour déterminer les facteurs de risque. RÉSULTATS: L'incidence de plagiocéphalie positionnelle a été évaluée à 46,6 %. Les facteurs de risque suivants ont été déterminés au moyen de la régression logistique multiple : préférence positionnelle de la tête à droite (RC 4,66 [95 % IC 2,85 à 7,58]; P<0,001), préférence positionnelle de la tête à gauche (RC 4,21 [95 % IC 2,45 à 7,25]; P<0,001), position de sommeil en décubitus dorsal (RC 2,67 [95 % IC 1,58 à 4,51]; P<0,001), accouchement assisté par ventouses ou forceps (RC 1,88 [95 % IC 1,02 à 3,49]; P=0,04) et sexe masculin (RC 1,55 [95 % IC 1,00 à 2,38]; P=0,05). CONCLUSION: Il faut conseiller aux parents ou aux tuteurs de modifier la position de la tête du nourrisson bien avant le rendez-vous à la clinique pour enfants en santé à deux mois. Ces conseils pourraient être donnés pendant la période prénatale par les dispensateurs ou les éducateurs de soins prénatals ou par des infirmières postnatales ou des infirmières de santé publique pendant la période néonatale. On peut donner des conseils de prévention aux parents ou aux tuteurs des nourrissons de sexe masculin et de ceux qui ont eu un accouchement assisté.

Feasibility of community-based screening for cardiovascular disease risk in an ethnic community: the South Asian Cardiovascular Health Assessment and Management Program (SA-CHAMP).

BACKGROUND: South Asian Canadians experience disproportionately high rates of cardiovascular disease (CVD). The goal of this qualitative study was to determine the feasibility of implementing a sustainable, culturally adapted, community-based CVD risk factor screening program for this population. METHODS: South Asians (≥ 45 years) in Calgary, Alberta underwent opportunistic cardiovascular risk factor screening by lay trained volunteers at local religious facilities. Those with elevated blood pressure (BP) or ≥ 1 risk factor underwent point of care cholesterol testing, 10-year CVD risk calculation, counseling, and referral to family physicians and local culturally tailored chronic disease management (CDM) programs. Participants were invited for re-screening and were surveyed about health system follow-up, satisfaction with the program and suggestions for improvement. Changes in risk factors from baseline were estimated using McNemar's test (proportions) and paired t-tests (continuous measures). RESULTS: Baseline assessment was completed for 238 participants (median age 64 years, 51% female). Mean TC, HDL and TC/HDL were 5.41 mmol/L, 1.12 mmol/L and 4.7, respectively. Mean systolic and diastolic blood pressures (mmHg) were 129 and 75 respectively. Blood pressure and TC/HDL ratios exceeded recommended targets in 36% and 58%, respectively, and 76% were at high risk for CVD. Ninety-nine participants (47% female) attended re-screening. 82% had accessed health care providers, 22% reported medication changes and 3.5% had attended the CDM programs. While BP remained unchanged, TC and TC/HDL decreased and HDL increased significantly (mean differences: -0.52 mmol/L, -1.04 and +0.07 mmol/L, respectively). Participants were very satisfied (80%) or satisfied (20%) with the project. Participants suggested screening sessions and CDM programs be more accessible by: delivering evening or weekends programs at more sites, providing transportation, offering multilingual programs/translation assistance, reducing screening wait times and increasing numbers of project staff. CONCLUSIONS: SA-CHAMP demonstrated the feasibility and value of implementing a lay volunteer-led, culturally adapted, sustainable community-based CVD risk factor screening program in South Asian places of worship in Calgary, Alberta, Canada. Subsequent screening and CDM programs were refined based on the learnings from this study. Further research is needed to determine physician and patient factors associated with uptake of and adherence to risk reduction strategies.

Defining the role of primary health care nurse practitioners in rural Nova Scotia.

This article reports on a mixed methods study to define the role of nurse practitioners (NPs) in rural Nova Scotia, Canada, by collecting the perceptions of rural health board chairpersons and health-care providers. Qualitative data were collected in telephone interviews with health board chairpersons. Quantitative data were collected in a survey of NPs, family physicians, public health nurses, and family practice nurses.The authors describe participants' perspectives on the health needs of rural communities, the gaps in the current model of primary health care services, the envisaged role of NPs in rural communities, and the facilitators of and barriers to NP role implementation. Optimizing the benefits of the NP role for residents of rural communities requires attention to the barriers that impede deployment and integration of the role.

Childhood obesity: perceptions held by the public in Calgary, Canada.

OBJECTIVE: To investigate the perceptions about causes and prevention of childhood obesity held by the adult public in Calgary, Canada. DESIGN: Using a cross-sectional survey design, adults were recruited from a shopping mall located in a region of Calgary, Alberta characterized by mixed ethnic and socio-economic residents. SUBJECTS: 264 adults in Calgary, Canada. MEASUREMENTS: Participants completed a self-administered questionnaire that involved rating the importance of 25 potential causes of obesity and 13 potential preventive measures, using a four-point Likert scale anchored by "not important" and "very important". Demographic information including age, sex, educational level, parental status, and self-reported weight and height was also collected. RESULTS: Principal components analysis of questionnaire items revealed five "cause" factors ('parental responsibility', 'over-consumption and media promotion of unhealthy foods', 'misuse/overuse of modern technology', 'children's lack of knowledge and motivation', 'physical activity environment') and two "prevention" factors ('healthy public/private policy and targeted intervention', and 'media campaigns and compulsory physical education'). Tests for group differences revealed that women ranked 'over-consumption of unhealthy foods and media influence' and 'physical activity environment' as more important causes of childhood obesity than men. Additionally, persons classified as obese ranked 'misuse/overuse of modern technology' and 'healthy public/private policy and targeted intervention' as more important than those persons classified as under/normal weight. CONCLUSION: By providing a snapshot of views held by the public regarding childhood obesity in this large Canadian city, this study offers preliminary guidance about publicly acceptable intervention strategies for use by health promotion researchers and policy-makers.

"Inside and outside": Sikh women's perspectives on cervical cancer screening.

Cervical cancer can be detected at an early stage through regular screening. The literature suggests that cervical cancer in immigrant women, a growing population in Canada, is less likely to be detected early than it is in the general population, as immigrant women tend not to take advantage of screening. Culturally appropriate screening services for immigrant women are few. A qualitative descriptive study was conducted with female members of an urban Sikh community in Canada to explore perspectives on cervical cancer screening. In-depth interviews (13) and focus groups (3) were carried out to uncover challenges to cervical cancer screening. The researchers identified a prevailing theme of "inside/outside" whereby the women felt confined to their community, finding it difficult to move "outside" into Canadian society in order to participate in screening. Lack of knowledge about the importance of prevention, influence of family and community, and health-provider issues affected the women's access to screening. The results will be helpful for nurses planning and delivering screening services to Sikh women.

Seeking serenity: living with HIV/AIDS in rural Western Canada.

INTRODUCTION: The purpose of this naturalistic inquiry was to describe the experience of living with HIV infection in rural Alberta, Canada. Although the urban HIV epidemic has been well researched, the virus continues its spread into more remote populations where there is a need to understand and address its impact. Affected rural residents form a diverse and marginalized group that includes women, Aboriginal peoples, immigrants, injecting drug users, and men who have sex with men, yet there are few data available to inform appropriate health and social services and practice. A number of factors, such as stigma, invisibility, isolation, confidentiality, poverty, and risk behaviours, contribute to the rural experience, but have not been clearly explicated in the literature. This study was conducted in order to better understand the perceptions of health in a rural setting, the processes involved in accessing care, the challenges and benefits associated with rural life, and the relationship between personal beliefs and values and the nature of the disease. METHOD: Semi-structured interviews were conducted with six HIV-seropositive individuals and one caregiver who were living or had lived in rural settings, as well as four AIDS agency staff from a small city. Participants represented varied backgrounds, ages, sexual orientations, exposure to risk behaviours, lifestyles, roles, and citizenship. A naturalist inquiry approach was used in order to explore the qualitative aspects of the experience. Interviews were recorded, transcribed, and analyzed. Documents such as poetry, letters, field notes and journals served to enrich the data. RESULTS: Participants identified the components of health as a sense of wellbeing, quality of life, and independence. Within the context of HIV infection, health was achieved through three processes: (1) accommodating the reality of the diagnosis into daily life; (2) creating and engaging in supportive relationships and communities; and (3) reflecting on the meaning of one's life and future. Rural life had various meanings and implications for individuals, in terms of security, comfort, relationships, access to services, attitudes, dignity, and justice. Barriers and challenges to reaching health centred around a lack of skill and knowledge in human services workers, violation of confidentiality, difficulty associated with travel for medical care, and inadequate support for family caregivers. Participants suggested that the health of the community is reflected in the health of individuals. They expressed the hope that some day diversity would not only be tolerated, but would be celebrated by all members of society. CONCLUSIONS: Rural residents perceive and enact health in distinct ways. Caregivers must understand that health usually represents a concern only after it has failed and self-initiated attempts to overcome problems have been unsuccessful. Participants in this study articulated their need to live in a society that acknowledges their diversity and honours their rights to access health and social supports in the community. Service providers may enhance care and promote health of this aggregate through education, attention to professional responsibilities, fostering resilient communities, and advocating for vulnerable members of society. Further research needs to be conducted in order to learn more about the relationships between HIV infection and rural living and the needs of people who live in such situations. With this knowledge, appropriate healthcare services can be developed and implemented to enhance the wellbeing and quality of life for individuals, families, and communities.

Vaccination for Group B Streptococcus during pregnancy: attitudes and concerns of women and health care providers.

Group B Streptococcus (GBS) is the leading infectious cause of neonatal morbidity and mortality. Although intrapartum antibiotic prophylaxis (IAP) strategies are effective in preventing GBS transmission from mothers to newborns, there are growing concerns about adverse effects, and the development of antibiotic resistance. GBS vaccines targeting the most virulent neonatal disease serotypes are currently under development and may be used during pregnancy. The objective of this study was to explore the key issues and concerns that would be associated with GBS vaccination during pregnancy from the perspectives of pregnant women and health care providers. Twenty-two women and 25 health care professionals in Alberta, Canada participated in 10 focus groups, each group ranging from 2 to 20 participants. Valuable information emerged from the focus groups about the factors that would affect acceptance of a maternal GBS vaccine. This information will be essential for health systems to consider in the introduction, promotion and delivery of such a vaccine. The data may help optimize education about GBS and a putative vaccine to pregnant women.

At what cost to health? Tlicho women's medical travel for childbirth.

Medical travel policies are instituted in all rural and remote areas of Canada as a means of providing universal health care services to residents. These policies are framed, developed and implemented from a colonial perspective and require re-examination through a more inclusive and collaborative postcolonial lens. The purpose of this paper is to discuss the medical travel policy for childbirth in Canada's Northwest Territories from a postcolonial perspective and in consideration of the cultural safety of pregnant Tlicho women. The context within which Tlicho birthing and this policy thrives is reviewed along with the exploration of future possibilities. Personal, socioeconomic, political and legal factors surrounding birthing are highlighted. It is anticipated, that by illuminating the oppressive and paternalistic nature of this childbirth policy, there will be heightened awareness that fosters transitions within the system to transform current risk discourse creating new possibilities for Tlicho women in the birth of their babies.

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.

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.

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.

A focused ethnographic study of Alberta cattle veterinarians' decision making about diagnostic laboratory submissions and perceptions of surveillance programs.

The animal and public health communities need to address the challenge posed by zoonotic emerging infectious diseases. To minimize the impacts of future events, animal disease surveillance will need to enable prompt event detection and response. Diagnostic laboratory-based surveillance systems targeting domestic animals depend in large part on private veterinarians to submit samples from cases to a laboratory. In contexts where pre-diagnostic laboratory surveillance systems have been implemented, this group of veterinarians is often asked to input data. This scenario holds true in Alberta where private cattle veterinarians have been asked to participate in the Alberta Veterinary Surveillance Network-Veterinary Practice Surveillance, a platform to which pre-diagnostic disease and non-disease case data are submitted. Consequently, understanding the factors that influence these veterinarians to submit cases to a laboratory and the complex of factors that affect their participation in surveillance programs is foundational to interpreting disease patterns reported by laboratories and engaging veterinarians in surveillance. A focused ethnographic study was conducted with ten cattle veterinarians in Alberta. Individual in-depth interviews with participants were recorded and transcribed to enable thematic analysis. Laboratory submissions were biased toward outbreaks of unknown cause, cases with unusual mortality rates, and issues with potential herd-level implications. Decreasing cattle value and government support for laboratory testing have contributed to fewer submissions over time. Participants were willing participants in surveillance, though government support and collaboration were necessary. Changes in the beef industry and veterinary profession, as well as cattle producers themselves, present both challenges and opportunities in surveillance.

The incidence of positional plagiocephaly: a cohort study.

OBJECTIVE: The objective of this study was to estimate the incidence of positional plagiocephaly in infants 7 to 12 weeks of age who attend the 2-month well-child clinic in Calgary, Alberta, Canada. METHODS: A prospective cohort design was used to recruit 440 healthy full-term infants (born at ≥37 weeks of gestation) who presented at 2-month well-child clinics for public health nursing services (eg, immunization) in the city of Calgary, Alberta. The study was completed in 4 community health centers (CHCs) from July to September 2010. The CHCs were selected based on their location, each CHC representing 1 quadrant of the city. Argenta's (2004) plagiocephaly assessment tool was used to identify the presence or absence of plagiocephaly. RESULTS: Of the 440 infants assessed, 205 were observed to have some form of plagiocephaly. The incidence of plagiocephaly in infants at 7 to 12 weeks of age was estimated to be 46.6%. Of all infants with plagiocephaly, 63.2% were affected on the right side and 78.3% had a mild form. CONCLUSIONS: To our knowledge, this is the first population-based study to investigate the incidence of positional plagiocephaly using 4 community-based data collection sites. Future studies are required to corroborate the findings of our study. Research is required to assess the incidence of plagiocephaly using Argenta's plagiocephaly assessment tool across more CHCs and to assess prevalence at different infant age groups. The utility of using Argenta's plagiocephaly assessment tool by public health nurses and/or family physicians needs to be established.

A focused ethnographic study of Sri Lankan government field veterinarians' decision making about diagnostic laboratory submissions and perceptions of surveillance.

The global public health community is facing the challenge of emerging infectious diseases. Historically, the majority of these diseases have arisen from animal populations at lower latitudes where many nations experience marked resource constraints. In order to minimize the impact of future events, surveillance of animal populations will need to enable prompt event detection and response. Many surveillance systems targeting animals rely on veterinarians to submit cases to a diagnostic laboratory or input clinical case data. Therefore understanding veterinarians' decision-making process that guides laboratory case submission and their perceptions of infectious disease surveillance is foundational to interpreting disease patterns reported by laboratories and engaging veterinarians in surveillance initiatives. A focused ethnographic study was conducted with twelve field veterinary surgeons that participated in a mobile phone-based surveillance pilot project in Sri Lanka. Each participant agreed to an individual in-depth interview that was recorded and later transcribed to enable thematic analysis of the interview content. Results found that field veterinarians in Sri Lanka infrequently submit cases to laboratories--so infrequently that common case selection principles could not be described. Field veterinarians in Sri Lanka have a diagnostic process that operates independently of laboratories. Participants indicated a willingness to take part in surveillance initiatives, though they highlighted a need for incentives that satisfy a range of motivations that vary among field veterinarians. This study has implications for the future of animal health surveillance, including interpretation of disease patterns reported, system design and implementation, and engagement of data providers.

Influenza vaccination by registered nurses: a personal decision.

Influenza is a contagious respiratory virus that causes high rates of morbidity and mortality and is associated with life-threatening complications. Despite the wide availability of a highly effective influenza vaccine, nurses are reluctant to receive influenza vaccination and vaccination rates among them are low. The purpose of this study was to generate a substantive theory/theoretical model regarding the phenomenon of influenza vaccination uptake by registered nurses (RNs). The study used grounded theory to develop a deeper understanding of RNs' decision-making regarding the acceptance or refusal to be vaccinated against influenza in Nova Scotia, Canada. Data were collected from 11 RNs using an unstructured and conversational interview format and analysed using the constant comparative method. The primary finding of this study is that nurses consider getting vaccinated to be a personal decision (the core variable). Their decisions are based on sources of information (including formal education, continuing education and the media); personal knowing (personal philosophy, perceived risks and benefits and personal experience); and personal modifiers (the availability and accessibility of the vaccine). The process of making a personal decision defined in this study provides a framework for creating more effective influenza immunization education and delivery programs.