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Rybarczyk-Szwajkowska A, Rydlewska-Liszkowska I. Priority Setting in the Polish Health Care System According to Patients' Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031178. [PMID: 33525746 PMCID: PMC7908543 DOI: 10.3390/ijerph18031178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/12/2021] [Accepted: 01/25/2021] [Indexed: 12/03/2022]
Abstract
Identification of health priorities is concerned with equitable distribution of resources and is an important part of strategic planning in the health care system. The aim of this article is to describe health priorities in the Polish health care system from the patients’ perspective. The study included 533 patients hospitalized in the Lodz region. The average age of the respondents was 48.5 years and one third (36.6%) had university education. Most of the respondents (64.9%) negatively assessed the functioning of the health care system in Poland. Most of them claimed the following aspects require improvements: financing health services (85.8%), determining priorities in health care (80.3%), the role of health insurance (80.3%), and medical education (70.8%). Over 70% of the respondents agreed the role of politicians in designing and implementing health system reforms should be limited. The fact that the respondents so negatively assessed the Polish health care system implies there is a need for full discussion on redefining health priorities.
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Abstract
Consumer engagement is increasingly emphasized in healthcare initiatives and has been a priority in healthcare reforms. Consumer engagement takes multiple forms, including increased involvement of consumers in their own care, in organizational design, and in broader policy decision-making processes. Determining the effectiveness of such involvement requires both effective measurement and empirical study, both of which have yet to be standardized or fully explored. In this review, we examine both existing measurement tools for consumer engagement and current empirical knowledge regarding the outcomes associated with each of three levels of consumer engagement. Although measurement and results at the level of direct care are more established, measurement of consumer engagement, let alone its effects at the organizational design or policy level, is less well developed. Building on our review, we make suggestions for how to fill the current gaps in understanding the measurement and outcomes of consumer engagement.
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Webb Hooper M, Mitchell C, Marshall VJ, Cheatham C, Austin K, Sanders K, Krishnamurthi S, Grafton LL. Understanding Multilevel Factors Related to Urban Community Trust in Healthcare and Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183280. [PMID: 31500126 PMCID: PMC6765868 DOI: 10.3390/ijerph16183280] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/31/2019] [Accepted: 09/02/2019] [Indexed: 12/19/2022]
Abstract
Background: Community and patient engagement in the healthcare system and biomedical research are prerequisites for eliminating health disparities. We conducted a “listening tour” to enhance our understanding of multilevel factors associated with community trust. Methods: Using community-based participatory research (CBPR) methods, we conducted a phenomenological qualitative study. “Town-hall” style discussions were held at nine sites across an urban, Midwestern city. We recruited adults (N = 130) via community networks, social media, flyers, and word-of-mouth. Demographic assessments were self-administered and listening tour sessions were conducted by trained moderators. Themes were framed within the social ecological model (SEM; intrapersonal, interpersonal, institutional, community, and policy levels). Results: Participants were mostly female (68%), African American (80%), had health coverage (97%) and were diagnosed with a chronic health condition (71%). The overarching theme was sociodemographic differences in distrust, such that African Americans and deaf/hearing impaired participants perceived disparities in healthcare, a lower quality of care, and skepticism about biomedical research, relative to Whites. Conclusions: The depth of distrust for healthcare providers, systems, and researchers in underserved communities remains strong and complex. Findings highlight the need to understand the lived experiences of community members, and how distrust is maintained. Multilevel interventions to increase trust and the accrual of underrepresented populations into clinical trials are needed.
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Affiliation(s)
- Monica Webb Hooper
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Charlene Mitchell
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Vanessa J Marshall
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
- University Hospitals Cleveland Medical Center, Seidman Cancer Center, Cleveland, OH 44106, USA
| | - Chesley Cheatham
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
- University Hospitals Cleveland Medical Center, Seidman Cancer Center, Cleveland, OH 44106, USA
| | | | - Kimberly Sanders
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA
| | - Smitha Krishnamurthi
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA
| | - Lena L Grafton
- NEOMED-CSU Partnership for Urban Health, Cleveland State University, Cleveland, OH 44115, USA
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Erves JC, Mayo-Gamble TL, Malin-Fair A, Boyer A, Joosten Y, Vaughn YC, Sherden L, Luther P, Miller S, Wilkins CH. Needs, Priorities, and Recommendations for Engaging Underrepresented Populations in Clinical Research: A Community Perspective. J Community Health 2018; 42:472-480. [PMID: 27812847 PMCID: PMC5408035 DOI: 10.1007/s10900-016-0279-2] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Engaging underrepresented groups in outcomes research is a public health priority for reducing health and health care disparities; yet, engaging these groups is challenging. Failure to involve these underrepresented populations in research further exacerbates these disparities. This article presents the health and research priorities of diverse groups of underrepresented populations in biomedical research, their concerns for participating in research, and strategies to engage them in their healthcare and research studies. Eleven community listening sessions, ranging from 7 to 13 community members each (N = 117), representing racial/ethnic minority, economically disadvantaged (e.g., uninsured), and hearing impaired communities. We used an inductive, qualitative content analysis approach to analyze the data for emerging themes. We identified the following themes: Uncertainties of underrepresented populations regarding research participation; Ineffective communication about research opportunities and research findings; Research on primary care and prevention are priorities for underrepresented populations in research; and Research teams need training in cultural competence and humility. Underrepresented groups provided research priorities, concerns, and strategies to engage them in their healthcare and in research studies. Findings from this study could facilitate improvement of research participation among underrepresented groups, ultimately reducing health disparities and improving quality of life among groups commonly omitted from research recruitment and participation.
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Affiliation(s)
| | - Tilicia L Mayo-Gamble
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, 37208, USA
| | - Alecia Malin-Fair
- Vanderbilt Institute for Clinical Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, 37203, USA
| | - Alaina Boyer
- National Health Care for the Homeless Council, Nashville, TN, USA
| | - Yvonne Joosten
- Vanderbilt University School of Medicine and Vanderbilt Institute for Medicine and Public Health, Nashville, TN, 37203, USA
| | - Yolanda C Vaughn
- Meharry-Vanderbilt Alliance and Vanderbilt University, Nashville, TN, 37208, USA
| | - Lisa Sherden
- Johns Hopkins Center to Reduce Cancer Disparities, Baltimore, MD, 21287, USA
| | | | - Stephania Miller
- Department of Surgery, Meharry Medical College, Nashville, TN, 37208, USA
| | - Consuelo H Wilkins
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd., BioMedical Building, Nashville, TN, 37208, USA.
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Abstract
Although community advisory boards (CABs) are widely used in clinical research, there is limited data regarding their composition and structure, especially in Africa. Our research provides the first qualitative study of the membership practices, selection methods, and qualifications of the six major HIV research centers that comprise the Ugandan National CAB Network (UNCN). Researchers conducted interviews ( n = 45) with CAB members and research liaisons at each of the sites. While selection practices and demographics varied between the sites, all six CABs exclusively followed a broad community membership model. Results suggest successful CABs are context dependent and thus distinct guidelines may be needed based on variables including CAB funding level, representation model, and research focus.
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Affiliation(s)
- Carlton Lawrence
- 1 Duke University, Durham, NC, USA.,2 Harvard Medical School, Boston, MA, USA
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Wright B, Ricketts TC. When patients govern: federal grant funding and uncompensated care at federally qualified health centers. J Health Care Poor Underserved 2014; 24:954-67. [PMID: 23728059 DOI: 10.1353/hpu.2013.0068] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine if the proportion of consumers on federally qualified health center (FQHC) governing boards is associated with their use of federal grant funds to provide uncompensated care. METHODS Using FQHC data from the Uniform Data System, county-level data from the Area Resource File and governing board data from FQHC grant applications, the uncompensated care an FQHC provides relative to the amount of its federal funding is modeled as a function of board and executive committee composition using fixed-effects regression with FQHC and county-level controls. RESULTS Consumer governance does not predict how much uncompensated care an FQHC provides relative to the size of its federal grant. Rather, the proportion of an FQHC's patient-mix that is uninsured drives uncompensated care provision. CONCLUSIONS Aside from a small executive committee effect, consumer governance does not influence FQHCs' provision of uncompensated care. More work is needed to understand the role of consumer governance.
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Affiliation(s)
- Brad Wright
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI 02912, USA.
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Ross LF, Loup A, Nelson RM, Botkin JR, Kost R, Smith GR, Gehlert S. The challenges of collaboration for academic and community partners in a research partnership: points to consider. J Empir Res Hum Res Ethics 2010; 5:19-31. [PMID: 20235861 PMCID: PMC2946316 DOI: 10.1525/jer.2010.5.1.19] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The philosophical underpinning of Community-Engaged Research (CEnR) entails a collaborative partnership between academic researchers and the community. The Community-Based Participatory Research (CBPR) model is the partnership model most widely discussed in the CEnR literature and is the primary model we draw upon in this discussion of the collaboration between academic researchers and the community. In CPBR, the goal is for community partners to have equal authority and responsibility with the academic research team, and that the partners engage in respectful negotiation both before the research begins and throughout the research process to ensure that the concerns, interests, and needs of each party are addressed. The negotiation of a fair, successful, and enduring partnership requires transparency and understanding of the different assets, skills and expertise that each party brings to the project. Delineating the expectations of both parties and documenting the terms of agreement in a memorandum of understanding or similar document may be very useful. This document is structured to provide a "points- to-consider" roadmap for academic and community research partners to establish and maintain a research partnership at each stage of the research process.
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Makundi E, Kapiriri L, Norheim OF. Combining evidence and values in priority setting: testing the balance sheet method in a low-income country. BMC Health Serv Res 2007; 7:152. [PMID: 17892561 PMCID: PMC2096625 DOI: 10.1186/1472-6963-7-152] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Accepted: 09/24/2007] [Indexed: 11/19/2022] Open
Abstract
Background Procedures for priority setting need to incorporate both scientific evidence and public values. The aim of this study was to test out a model for priority setting which incorporates both scientific evidence and public values, and to explore use of evidence by a selection of stakeholders and to study reasons for the relative ranking of health care interventions in a setting of extreme resource scarcity. Methods Systematic search for and assessment of relevant evidence for priority setting in a low-income country. Development of a balance sheet according to Eddy's explicit method. Eight group interviews (n-85), using a modified nominal group technique for eliciting individual and group rankings of a given set of health interventions. Results The study procedure made it possible to compare the groups' ranking before and after all the evidence was provided to participants. A rank deviation is significant if the rank order of the same intervention differed by two or more points on the ordinal scale. A comparison between the initial rank and the final rank (before deliberation) showed a rank deviation of 67%. The difference between the initial rank and the final rank after discussion and voting gave a rank deviation of 78%. Conclusion Evidence-based and deliberative decision-making does change priorities significantly in an experimental setting. Our use of the balance sheet method was meant as a demonstration project, but could if properly developed be feasible for health planners, experts and health workers, although more work is needed before it can be used for laypersons.
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Affiliation(s)
- Emmanuel Makundi
- National Institute for Medical Research, Dar es Salaam, Tanzania
- Centre for International Health, University of Bergen, Norway
| | - Lydia Kapiriri
- University of Toronto Joint Centre for Bioethics, Toronto, Ontario, Canada
| | - Ole Frithjof Norheim
- Centre for International Health, University of Bergen, Norway
- Division for Medical Ethics, Department of Public Health and Primary Health Care, University of Bergen, Norway
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Richmond TS, Schwab CW, Riely J, Branas CC, Cheney R, Dunfey M. Effective Trauma Center Partnerships to Address Firearm Injury: A New Paradigm. ACTA ACUST UNITED AC 2004; 56:1197-205. [PMID: 15211125 DOI: 10.1097/01.ta.0000130760.87714.0e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Firearm violence is the second leading cause of injury-related death. This study examined the use of local trauma centers as lead organizations in their communities to address firearm injury. METHODS Three trauma centers in cities with populations less than 100,000 were linked with a university-based firearm injury research center. A trauma surgeon director and coordinator partnered with communities, recruited and directed advisory boards, established a local firearm injury surveillance system, and informed communities using community-specific profiles. Primary process and outcome measures included completeness of data, development of community-specific profiles, number of data-driven consumer media pieces, number of meetings to inform policy makers, and an analysis of problems encountered. RESULTS Local trauma centers in smaller communities implemented a firearm injury surveillance system, produced community-specific injury profiles, and engaged community leaders and policy makers to address firearm injury. Community-specific profiles demonstrated consistent firearm suicide rates (6.58-6.82 per 100,000) but variation in firearm homicide rates (1.08-12.5 per 100,000) across sites. There were 63 data-driven media pieces and 18 forums to inform community leaders and policy makers. Completeness of data elements ranged from 57.1% to 100%. Problems experienced were disconnected data sources, multiple data owners, potential for political fallout, limited trauma center data, skills sets of medical professionals, and sustainability. CONCLUSION Trauma centers, when provided resources and support, with the model described, can function as lead organizations in partnering with the community to acquire and use community-specific data for local firearm injury prevention.
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Affiliation(s)
- Therese S Richmond
- Firearm and Injury Center at Penn, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Buck DS, Rochon D, Davidson H, McCurdy S. Involving homeless persons in the leadership of a health care organization. QUALITATIVE HEALTH RESEARCH 2004; 14:513-525. [PMID: 15068577 DOI: 10.1177/1049732303262642] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Consumer advisory boards (CABs) are a way of involving patients in their health care. To engage the homeless in the administration of a health care organization for the homeless, a service agency formed such a board comprising homeless and formerly homeless individuals. The purpose was to integrate experiences of homelessness into programmatic design and research efforts of the organization, and to promote participatory research among the homeless. A content analysis and member checking revealed four distinct themes relating to committee goals, identity definition, power, and issues and needs of the homeless. Findings indicate that participatory research provided a useful structure in which the CAB could improve self-sufficiency and self-efficacy, and contribute to the direction of the health care agency.
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Frankish CJ, Kwan B, Ratner PA, Higgins JW, Larsen C. Challenges of citizen participation in regional health authorities. Soc Sci Med 2002; 54:1471-80. [PMID: 12061482 DOI: 10.1016/s0277-9536(01)00135-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Citizen participation has been included as part of health reform, often in the form of lay health authorities. In Canada, these authorities are variously known as regional health boards or councils. A set of challenges is associated with citizen participation in regional health authorities. These challenges relate to: differences in opinion about whether there should be citizen participation at all; differences in perception of the levels and processes of participation; differences in opinion with respect to the roles and responsibilities of health authority members; differences in opinion about the appropriate composition of the authorities; differences in opinion about the requisite skills and attributes of health authority members; having a good support base (staff, good information, board development); understanding and operationalizing various roles of the board (governance and policy setting) versus the board staff (management and administration); difficulties in ensuring the accountability of the health authorities; and measuring the results of the work and decisions of the health authorities. Despite these challenges, regional health authorities are gaining support as both theoretically sound and pragmatically based approaches to health-system reform. This review of the above challenges suggests that each of the concerns remains a significant threat to meaningful public participation.
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Affiliation(s)
- C James Frankish
- Institute of Health Promotion Research, University of British Columbia, Vancouver, Canada.
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MacQueen KM, McLellan E, Metzger DS, Kegeles S, Strauss RP, Scotti R, Blanchard L, Trotter RT. What is community? An evidence-based definition for participatory public health. Am J Public Health 2001; 91:1929-38. [PMID: 11726368 PMCID: PMC1446907 DOI: 10.2105/ajph.91.12.1929] [Citation(s) in RCA: 228] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Increased emphasis on community collaboration indicates the need for consensus regarding the definition of community within public health. This study examined whether members of diverse US communities described community in similar ways. To identify strategies to support community collaboration in HIV vaccine trials, qualitative interviews were conducted with 25 African Americans in Durham, NC; 26 gay men in San Francisco, Calif; 25 injection drug users in Philadelphia, Pa; and 42 HIV vaccine researchers across the United States. Verbatim responses to the question "What does the word community mean to you?" were analyzed. Cluster analysis was used to identify similarities in the way community was described. A common definition of community emerged as a group of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in joint action in geographical locations or settings. The participants differed in the emphasis they placed on particular elements of the definition. Community was defined similarly but experienced differently by people with diverse backgrounds. These results parallel similar social science findings and confirm the viability of a common definition for participatory public health.
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Affiliation(s)
- K M MacQueen
- National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Eyles J, Brimacombe M, Chaulk P, Stoddart G, Pranger T, Moase O. What determines health? To where should we shift resources? Attitudes towards the determinants of health among multiple stakeholder groups in Prince Edward Island, Canada. Soc Sci Med 2001; 53:1611-9. [PMID: 11762887 DOI: 10.1016/s0277-9536(00)00445-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The population health perspective has become significant in academic and policy discourse. The purpose of this paper is to assess its significance among health care practitioners and administrators as well as the general public. Respondents in Prince Edward Island, Canada were asked to rank the broad determinants of health and comment on to where resources should be shifted to improve the health of the population. Important variations are noted between the groups with family physicians and front-line staff being similar in perceptions to the general public on most determinants than other groups. The paper concludes with discussion on the relevance of the findings for population health research and health policy.
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Affiliation(s)
- J Eyles
- McMaster Institute of Environment and Health and School of Geography and Geology, McMaster University, Hamilton, Ont., Canada
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Macey J, Kreiger N, Sloan M, Lacroix J. Cancer prevention in the community: a survey of community residents. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2001. [PMID: 11257991 PMCID: PMC6979635 DOI: 10.1007/bf03404844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Lifestyle exposures account for the greatest proportion of risk factors for cancer, yet these exposures have proven most difficult to alter. Despite intensive intervention efforts, many behaviour change programs are ill suited to the community. This research was undertaken to increase our understanding of prevention activities of interest to a sample of residents in two Ontario communities. 248 (62.3%) adult residents responded to a semi-structured self-administered questionnaire including open-ended questions on health issues, exposures and prevention activities of interest. While some of the beliefs expressed by respondents might have been anticipated (e.g., cigarette smoking and family history increase risk of cancer), others were not (e.g., only between 40 and 75% of respondents thought a high fat diet increased risk). Furthermore, many of those with personal health concerns expressed an interest in prevention. This process is proposed as a first step in launching more appropriate and sustainable community-based health promotion programs for cancer prevention.
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Affiliation(s)
- Jeannette Macey
- Division of Prevention Oncology, Cancer Care Ontario, 620 University Avenue, Toronto, ON M5G 2L7 Canada
| | - Nancy Kreiger
- Division of Prevention Oncology, Cancer Care Ontario, 620 University Avenue, Toronto, ON M5G 2L7 Canada
- Department of Public Health Sciences, University of Toronto, Toronto, Ontario Canada
| | - Margaret Sloan
- Division of Prevention Oncology, Cancer Care Ontario, 620 University Avenue, Toronto, ON M5G 2L7 Canada
| | - Jeanie Lacroix
- Canadian Institute for Health Information, Toronto, Ontario Canada
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Guidotti TL, Ford L, Wheeler M. The Fort McMurray Demonstration Project in Social Marketing: theory, design, and evaluation. Am J Prev Med 2000; 18:163-9. [PMID: 10698248 DOI: 10.1016/s0749-3797(99)00133-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
CONTEXT The Fort McMurray Demonstration Project in Social Marketing is a multifaceted program that applies the techniques of social marketing to health and safety. This paper describes the origins of the project and the principles on which it was based. VENUE: Fort McMurray, in the province of Alberta, Canada, was selected because the community had several community initiatives already underway and the project had the opportunity to demonstrate "value added." CONCEPT The project is distinguished from others by a model that attempts to achieve mutually reinforcing effects from social marketing in the community as a whole and from workplace safety promotion in particular. DESIGN Specific interventions sponsored by the project include a media campaign on cable television, public activities in local schools, a community safety audit, and media appearance by a mascot that provides visual identity to the project, a dinosaur named "Safetysaurus." The project integrated its activities with other community initiatives. MAIN OUTCOME MEASURES The evaluation component emphasizes outcome measures. A final evaluation based on injury rates and attitudinal surveys is underway. RESULTS Baseline data from the first round of surveys have been compiled and published. In 1995, Fort McMurray became the first city in North America to be given membership in the World Health Organization's Safe Community Network.
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Affiliation(s)
- T L Guidotti
- Northern Centre for Work, Environment & Health, Edmonton, Alberta, Canada.
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Norheim OF. Healthcare rationing-are additional criteria needed for assessing evidence based clinical practice guidelines? BMJ (CLINICAL RESEARCH ED.) 1999; 319:1426-9. [PMID: 10574869 PMCID: PMC1117150 DOI: 10.1136/bmj.319.7222.1426] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- O F Norheim
- Division for General Practice, University of Bergen, N-5009 Bergen, Norway.
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