The adoption, implementation and maintenance of a school food policy in the Canadian Arctic: a retrospective case study.

With increasing childhood obesity rates and type 2 diabetes developing in younger age groups, many schools have initiated policies to support healthy eating and active living. Policy interventions can influence not only health behaviours in students but can also impact these behaviours beyond the school walls into the community. We articulate a policy story that emerged during the data collection phase of a study focused on building knowledge and capacity to support healthy eating and active living policy options in a small hamlet located in the Canadian Arctic. The policy processes of a local school food policy to address unhealthy eating are discussed. Through 14 interviews, decision makers, policy influencers and health practitioners described a policy process, retrospectively, including facilitators and barriers to adopting and implementing policy. A number of key activities facilitated the successful policy implementation process and the building of a critical mass to support healthy eating and active living in the community. A key contextual factor in school food policies in the Arctic is the influence of traditional (country) foods. This study is the first to provide an in-depth examination of the implementation of a food policy in a Canadian Arctic school. Recommendations are offered to inform intervention research and guide a food policy implementation process in a school environment facing similar issues.

Impacts of a Support Intervention for Zimbabwean and Sudanese Refugee Parents: "I Am Not Alone".

Knowledge about the beneficial effects of social support has not been used to systematically develop and evaluate interventions to help refugee new parents cope. The purpose of this study was to design and evaluate a social support intervention for refugee new parents. A multi-method research design was used and participatory research strategies were employed. Qualitative and quantitative measures were used to understand experiences of participants and to assess the perceived psychosocial and health-related outcomes of the intervention. Mentored support groups, matched by gender and ethnicity, met biweekly over 7 months. The participants were 48 Sudanese and 37 Zimbabwean refugee parents in 2 Canadian provinces. Increases were found in informational support, spousal support, community engagement, coping, and support-seeking. Decreases were found in parenting stress, loneliness, and isolation. The authors conclude that there is a need for culturally appropriate nursing practices and programs for refugee new parents from diverse cultures.

Les connaissances concernant les effets bénéfiques du soutien social n'ont pas été utilisées de manière systématique pour élaborer et évaluer les interventions visant à aider les réfugiés nouveaux parents à s'adapter à leur situation. L'objectif de cette étude est de concevoir et d'évaluer une intervention pour venir en aide aux réfugiés nouveaux parents. Diverses méthodes de recherche et différentes stratégies de recherche participative ont été utilisées pour la réalisation de l'étude. Des mesures quantitatives et qualitatives ont été effectuées pour comprendre l'expérience vécue par les participants et pour évaluer les résultats perçus de l'intervention sur les plans psychologique et de la santé. Des groupes de soutien encadrés et formés en fonction du sexe et de l'ethnie se sont réunis toutes les deux semaines pendant sept mois. L'ensemble des nouveaux parents participants comprenait 48 réfugiés soudanais et 37 réfugiés zimbabwéens établis dans deux provinces canadiennes. Ces groupes ont donné lieu à un accroissement du soutien informationnel, du soutien conjugal, de la participation communautaire, de l'adaptation et des demandes d'aide, ainsi qu'à une diminution du stress, de la solitude et de l'isolement des parents. En conclusion de leur étude, les auteurs signalent la nécessité d'adopter des programmes et des pratiques de soins infirmiers adaptés sur le plan culturel aux besoins des réfugiés nouveaux parents appartenant à diverses cultures.

Promoting Health Equity Research: Insights from a Canadian Initiative.

In 2002 the Canadian Institutes of Health Research launched a national initiative to promote health equity research reflecting the World Health Organization imperative of investment in health equity research. Funded researchers and teams have investigated health disparities faced by vulnerable populations, analyzed interactions of health determinants, and tested innovative interventions. Strategies for building research capacity have supported students, postdoctoral fellows, new investigators, and interdisciplinary research teams. Partnerships have been created with 10 national and 7 international organizations. Strategies used to secure and sustain this research initiative could be adapted to other contexts. Nurse scholars led the launch and have sustained the legacy of this national research initiative. Moreover, nurse researchers and research trainees, supported by the initiative, have contributed to the expansion and translation of the health equity knowledge base.

En 2002, les Instituts de recherche en santé du Canada ont lancé une initiative pancanadienne visant à promouvoir la recherche sur l'équité en matière de santé, conformément à une recommandation émise par l'Organisation mondiale de la Santé soulignant l'importance d'investir dans ce domaine. Les chercheurs et les équipes bénéficiant d'un financement se sont penchés sur les disparités touchant les populations vulnérables en matière de santé. Ils ont également analysé les interactions entre les déterminants de la santé et ont mis à l'épreuve des interventions novatrices. Des stratégies destinées à accroître la capacité de recherche ont appuyé les efforts des étudiants, des boursiers de recherches post-doctorales, des nouveaux chercheurs et des équipes de recherche interdisciplinaire. Des partenariats ont été créés avec dix organisations nationales et sept organisations internationales. Les stratégies utilisées pour consolider et soutenir cette initiative de recherche pourraient être adaptées à d'autres contextes. Les chercheurs en sciences infirmières ont assuré le lancement et maintenu l'héritage qu'a laissé cette initiative de recherche pancanadienne. De plus, les chercheurs et les stagiaires de recherche en sciences infirmières qui ont bénéficié de l'initiative ont contribué à l'expansion et à l'application de la base de connaissances sur l'équité en matière de santé.

Smoking prevention among youth: a multipronged approach involving parents, schools, and society.

The purpose of this research was to examine the perspectives of professionals on youth smoking prevention. The researchers used a qualitative descriptive design with a purposive sample of 9 professionals consisting of elementary school teachers, public health nurses, and tobacco control experts from non-governmental organizations. Data were collected through semi-structured interviews and were analyzed for themes. The view of the participants was that although parents have the main responsibility for educating their children about smoking, a multipronged approach, which also includes school and society more generally, will have the greatest effect. The need for a comprehensive, multifaceted, multichannel approach might explain why single smoking prevention interventions are often ineffective. Public health nurses are in a prime position to foster and support parents' smoking prevention interventions with their children and to advocate for strong tobacco control social policy and best practice for smoking prevention curricula in schools.

Where there is smoke, there is stress: low-income women identify support needs and preferences for smoking reduction.

Efforts to assist low-income women with tobacco reduction and cessation have typically not been informed by assessment of their needs and wishes. This multi-site qualitative study focused on assessing 64 low-income women's support needs and intervention preferences. These women were interested in smoking cessation, but identified many barriers and needed appropriate supports. However, available smoking cessation programs did not address underlying conditions, such as income instability and stress. The support recommended was psychosocial (e.g., buddy and group support), included self-care (e.g., nutrition, activity, and personal time), and reflected their social-economic circumstances (e.g., free cessation aids and child care).

'Health equity through action on the social determinants of health': taking up the challenge in nursing.

Reducing health inequities is a priority issue in Canada and worldwide. In this paper, we argue that nursing has a clear mandate to ensure access to health and health-care by providing sensitive empowering care to those experiencing inequities and working to change underlying social conditions that result in and perpetuate health inequities. We identify key dimensions of the concept of health (in)equities and identify recommendations to reduce inequities advanced in key global and Canadian documents. Using these documents as context, we advocate a 'critical caring approach' that will assist nurses to understand the social, political, economic and historical context of health inequities and to tackle these inequities through policy advocacy. Numerous societal barriers as well as constraints within the nursing profession must be acknowledged and addressed. We offer recommendations related to nursing practice, education and research to move forward the agenda of reducing health inequities through action on the social determinants of health.

Grounded theory, feminist theory, critical theory: toward theoretical triangulation.

Nursing and social science scholars have examined the compatibility between feminist and grounded theory traditions in scientific knowledge generation, concluding that they are complementary, yet not without certain tensions. This line of inquiry is extended to propose a critical feminist grounded theory methodology. The construction of symbolic interactionist, feminist, and critical feminist variants of grounded theory methodology is examined in terms of the presuppositions of each tradition and their interplay as a process of theoretical triangulation.

Employed mothers: stress and balance-focused coping.

This critical feminist grounded theory study examined how employed mothers coped with the stress of managing multiple responsibilities in family, health, and paid work. Over a 2-year period, 20 mothers employed as support staff in a large, publicly funded institution participated in repeated individual in-person and telephone interviews and in a focus group. Interviews were transcribed and analyzed using constant comparative methods. The women experienced stress from continuous demands in paid and family health work compounded by time constraints, inflexible expectations, conflicting demands, compromised personal resources, and inadequate support. Most of their coping strategies were individual, such as focusing on priorities, but some women used shared family decision-making. Findings support both individual and family stress and coping theory, yet underscore the need to explicate social-ecological influences such as relational power. Strategies that can enhance coping and reduce stress are described for nurses who work with women and families.

Promoting gender equity through health research: impacts and insights from a Canadian initiative.

The World Health Organization (WHO) recently identified major knowledge gaps regarding gender and sex as determinants of health. Canada recognized the importance of mobilizing research, and informing programs and policies focused on promoting the health of males and females across their lifespans by creating a national research institute that is focused on the study of gender, sex and health. No other country has created a national research institute dedicated to gender and health. Other countries may benefit from the strategies used by this Canadian research institute to create and sustain success, including: (i) mechanisms for defining national research priorities; (ii) tools to optimize research excellence; (iii) vehicles to build research capacity and develop a research community; (iv) processes to convert new knowledge into practice, programs and policies; (v) creation of partnerships at both the national and international levels and (vi) solutions to challenges and obstacles. The development of a vibrant research community and powerful national and international collaborations promotes gender and health equity.

Impacts of a support intervention for low-income women who smoke.

The objective of this pilot study was to implement and evaluate the impact of a support intervention tailored to the assessed support needs, resources and preferences of low-income women who smoke in three Canadian cities. The support intervention, informed by theoretical foundations, provided holistic one-to-one and group support over 14 weeks. The support intervention was facilitated by trained professional and peer facilitators. The impact was evaluated through analysis of qualitative and quantitative data collected at pre-, post-, and delayed post-test contacts. This analysis revealed that the intervention exerted positive impacts on smoking reduction/cessation, social networks, coping, and health behaviors. Participants reported satisfaction with the intervention.

Men family caregivers' experience of nonsupportive interactions: context and expectations.

Men's involvement as family caregivers has grown as the prevalence of dementia has increased. Men rely on support from others for caregiving but also experience nonsupportive interactions. The purpose of this ethnographic study of 34 men (24 spouses and 10 sons) caring for a relative with dementia, 5 assisting caregivers, and 15 professionals was to identify primary caregivers' perceptions of nonsupportive and supportive interactions in relationships with kin and friends as well as professionals. Thematic analysis of transcribed data generated from interviews, diaries, and focus group discussions revealed the nature of men's caregiving journeys, the characteristics of their social networks, and their expectations of supportive interactions. The nonsupportive interactions men caregivers experienced included a lack of orientation to the caregiving situation, an unsatisfactory linkage to support sources, insufficient support, and hurtful interactions. Information about nonsupportive interactions can sensitize kin and friends as well as professionals to the complexity of men's experience and potentially avoid unintended negative consequences of support efforts.

Meaning and action in employed mothers' health work.

The purpose of this critical feminist study was to examine employed mothers' meanings of family and personal health as they frame the context of daily experience in caring for their families' and their own health. Twenty mothers employed in support staff positions with a large institution in Western Canada participated in repeat interviews over 2 years. Women considered individual family members and the family group as they emphasized everyday function and satisfaction, and the presence or absence of various attributes of health as a multifaceted and dynamic experience. Women's health work included keeping track, constructing routines, facing challenges, setting priorities, being there for each other, finding joy and fulfillment, and fostering personal development. A preliminary typology of four orientations to family health work is suggested. Common themes between women's and family health and congruence between women's health meanings and actions provide guidance to nurses in family health promotion practice.

Interactive use of genograms and ecomaps in family caregiving research.

This article argues for the concurrent and comparative use of genograms and ecomaps in family caregiving research. A genogram is a graphic portrayal of the composition and structure of one's family and an ecomap is a graphic portrayal of personal and family social relationships. Although development and utilization of genograms and ecomaps is rooted in clinical practice with families, as research tools they provide data that can enhance the researcher's understanding of family member experiences. In qualitative research of the supportive and nonsupportive interactions experienced by male family caregivers, the interactive use of genograms and ecomaps (a) facilitated increased understanding of social networks as a context for caregiving, (b) promoted a relational process between researcher and participant, and (c) uncovered findings such as unrealized potential in the participant's social network that may not be revealed with the use of the genogram or ecomap alone, or the noncomparative use of both.

Embodied context: social institutional influences on employed mothers' health decision making.

The purpose of this critical ethnographic study was to explicate the ways that employed mothers' personal and family health decision making were socially organized through the institutions of motherhood, the family, the workplace, and the health care, education, and social systems in Canada. Data were analyzed from individual interviews, a focus group, workplace policy documents, and popular media articles. Twenty women participated over 2 years. Family, workplace, and social contexts were external influences on women's choices and were embodied through internal influences such as personal expectations that framed decision making. Strategies are suggested to promote the health and well-being of employed mothers and their families.

Women's satisfaction with their involvement in health care decisions during a high-risk pregnancy.

BACKGROUND: Increasingly, women seek involvement in decisions about their health care. The purpose of this study was to examine women's experience of, and satisfaction with, their involvement in health care decisions during a high-risk pregnancy. METHODS: Forty-seven women with hypertension or threatened preterm delivery (including multiple births) were interviewed after the birth of their child. They received prenatal care at home from nurses in a community program or were hospitalized. The in-depth interviews were audiotaped and transcribed; data were analyzed using constant comparative methods. RESULTS: Women identified an increased feeling of responsibility for the health of their baby and themselves, but differed in choosing active or passive involvement in health care decisions. Women who wanted active involvement achieved it through one of three processes: struggling for, negotiating, or being encouraged. Women who wanted passive involvement and women facing health crises used the process of trusting in the expertise of nurses and physicians. Women were satisfied if the care from health care professionals was congruent with how they wanted to be involved in decision-making. CONCLUSIONS: Although most women want to be actively involved in health decision-making during a high-risk pregnancy, some prefer a passive role. The setting of prenatal care, community-based or in-hospital, was less important than the ability of nurses and physicians to support the woman in her preferred role in decision-making.