Promoting Heart Health in Nova Scotia
- Organizational Development theory was used to understand and influence health promotion efforts in a five-year heart health promotion change initiative in Nova Scotia, Canada.
- Heart Health Nova Scotia, part of the Canadian Heart health Initiative, shifted its focus from community demonstration projects to capacity building of organizations.
- Previous community demonstration projects emphasized community mobilization, partnerships and environmental change while capacity building strengthened the organizational infrastructure of the province and dissemination and sustainability of heart health programs and policies.
- Organizational Development was selected as an intervention strategy because it "would enhance health promotion knowledge and practices of organizational members and provide them with opportunities to assess and explore how health promotion could be facilitated through their organization."
- OD was used to target 20 regional organizations in Nova Scotia including health, education and recreation sectors.
- Each regional organization had linkages to communities through chapters or local units, and either a mandate or a strong interest in health promotion.
The multifaceted OD intervention (1996 and 2001) included four specific strategies:
- Technical support
- Workshops on topics related to planning and implementing health promotion programs, such as health communication, advocacy, assessment and evaluation.
- Establishing a health promotion clearinghouse with a website on resources on health promotion topics and a contact list of people willing to share their health promotion experiences.
- Establishing community health action teams to implement specific activities that addressed at least one modifiable CVD risk factor.
- Action research using OD stages of diagnosis, assessment, intervention and evaluation, which involved cycles of assessment, action plan development, implementation, monitoring and evaluation and then development of new action plans based on monitoring data
- Organizational consultation focused on creating specific process and structural changes to support heart health infrastructure in participating organizations.
Evaluation of the Heart health Nova Scotia Initiative used both qualitative and quantitative methods to involve all initiative participants including, managers, coordinators, and volunteers.
Quantitative Methods: Network mapping questionnaire and technical support logs based on a tracking system.
- Organizational reflection logs that provided open-ended responses about participant reactions to policy changes, funds reallocations and partnerships
- Semi-structured interviews to monitor the effectiveness of the organizational development process, the facilitators and barriers to capacity building and the organizational change outcomes that resulted from capacity building.
Evaluation Variables: Partnership and organizational development for heart health promotion; the number, type, and effectiveness of the capacity-building strategies; and factors that influences capacity building, such as partner organizations' interest in heart health promotion, organizational readiness and leadership to engage in or support change and competing work priorities.
Process Evaluation Results:
- 41 workshops reached over 140 organizations and community health action teams conducted 18 initiatives that involved 39 organizations.
- Organizational representative reported increased knowledge and skills related to heart health promotion as a result of the various OD strategies applied
- New knowledge and skills were disseminated through application of the same tools and methods to new situations and through collaborative work with colleagues.
- Effective OD strategies include: new structured within organizations (e.g. committees), changes in organizational culture (e.g. increased communication and improved decision making)
- Interorganizational Relations Theory was used to understand and influence health promotion efforts across organizations involved in community coalition efforts.
- Eleven rural Appalachian cancer coalitions in Pennsylvania and New York used Community Coalitions Action Theory to develop community interventions on colorectal cancer.
- CCAT served as a conceptual framework for coalition development activities, interventions and analysis of change outcomes.
Goal: To determine whether cancer coalitions in rural Appalachia could 1) be linking agents to the community and 2) influence members organizations to be committed to and participate in dissemination materials to promote cancer awareness and screening.
- A computerized coalition data collection system was developed, based on an earlier system designed to monitor the activities and impact of cardiovascular disease coalitions.
- Field staff attended coalition meeting, followed up on coalition action plans, and recorded the relevant data electronically on nine forms.
- A generalized estimating equations model was used to test for temporal trends in the proportion of each initiative for each of the eleven coalitions.
Organizational Capacity: Several factors were categorized as indicative of organizational capacity by their correspondence to CCAT constructs. These factors include: lead agency, coalition membership (individuals and organizations), governance (leadership and staffing), geographic area served (context), mission statements, bylaws, subcommittees and cancer plans (structures).
Process: Several coalition development activities were characterized, including: meeting and agenda setting, assessment, implementation, and evaluation (referred to as operations and processes in CCAT).
Outcome and Impact: These include intermediate outcomes, including, funded proposals (pooled resources) and community interventions (implementation of strategies). Distal outcomes such as community changes were also included.
- Between 2002 and 2004, 11 Pennsylvania and New York coalitions conducted 1,369 activities: 16% were coalition development activities and 84% were community interventions.
- Interventions were classified according to type (outreach only, education only, outreach and education); screening, colorectal (37%), breast cancer (33%) or other focus(30%); demographic target priority by sex, age, income, profession or other characteristic.
- Forty-nine percent of the 3941 community residents reached through screening interventions completed the recommended behavioral change of being screened for cancer.
- Three of the eleven coalitions reported fifteen sustainable community changes such as offering free breast and cervical cancer screening to under-insured persons, funding screening activities and making space available for screening.
- Intermediate community changes included changes in partnership structure, programs or practices.
- Long term changes included sustained educational programs, screening practices, or health status changes resulting from community change.
- Coalitions focused twice as often on activities that were more likely to result in community changes (such as education and screening) rather than merely outreach and awareness building.
- The coalitions noted that their interventions were successful because of the long history and trusted relationships within their communities.