Advancing Health Promotion Priorities: Stories of Capacity Building from the Canadian Heart Health Initiative (CHHI).

The purpose of this paper is to explore how public health professionals built capacity to carry out health promotion despite a low level of investment and competition for financial resources with acute-oriented healthcare services. Three data sources are used in this analysis: key-informant interviews with project participants, final reports from three provincial Heart Health projects in Canada (Prince Edward Island, Ontario and Manitoba) and major provincial health policy documents prior to and during each project. We use a narrative policy analysis to identify contextual factors influencing health promotion priority and progress through capacity building. Common capacity building themes emerged from the data despite the different contexts within which the projects were situated: building community trust and support, developing a linking system that promotes provincial partnerships and assisting in sustainability efforts by coordinating resources and efforts towards a common chronic disease prevention strategy. Each of these provincial projects overcame instances of resistance to advancing a health promotion agenda by concentrating on building relationships, by making better use of existing structures and organizations and by developing new productive unions that shared a primary prevention agenda.

Issues in measuring health promotion capacity in Canada: a multi-province perspective.

Significant international progress has been made researching and addressing the economic and social burden of cardiovascular disease, advanced particularly by international conferences and subsequent declarations, and the Canadian Heart Health Initiative (CHHI). The implementation focus of the CHHI on building capacity for heart health promotion is paralleled by efforts to measure capacity. Through the collective experience of Heart Health Programs in Nova Scotia, Saskatchewan, Alberta and British Columbia, critical issues in measuring health promotion capacity are identified and strategies for addressing them are presented. The provincial contexts for the programs vary, as do the conceptualizations of capacity and intervention strategies to build capacity. Yet, despite such differences across provinces, shared issues influencing measuring capacity number many. These include: multiple understandings of terms; evolving understanding of capacity; invisibility of capacity building; detecting change within a dynamic system; staff turnover; time course required for change; attribution for change in capacity; understanding a process through 'snap-shot' measurements; lack of existing 'gold standard' measurement tools; validity and credibility of instruments; evolving nature of measurement tools; gathering perspectives from multiple levels within organizations; dealing with conflicting perspectives; and managing and disseminating sensitive data. A number of strategies have been devised or adopted to address measurement issues, ranging from adopting participatory processes to the development of monitoring systems. Understanding and addressing issues in measuring capacity deserve attention as they may be potent influences in the dynamic interplay between research and intervention in the process of capacity building in the context of health promotion generally, and/or heart health specifically.