Introduction

Background

This report presents the results of a telephone survey conducted with 13 channels in the Western Health Region of Nova Scotia. The purpose of the survey was to describe the heart health related activities (tobacco, nutrition, physical activity, and other heart health activities) that occurred in these channels over a one year period. These findings will be added to the results of subsequent inquiries (interviews, focus groups, and additional questionnaires) to describe the capacity for heart health in twenty-seven channels in the Western Health Region. Heart Health Nova Scotia is conducting this research as part of its Dissemination Research Phase.

Heart Health Nova Scotia, a member of the Canadian Heart Health Initiative, is funded by the Nova Scotia Department of Health and Health Canada via the National Health Research and Development Program (NHRDP). The Dissemination Research Phase is funded over a five year period, 1996-2001. Organizational capacity for heart health promotion will be estimated again near the end of the research period in 2001.

The Dissemination Research Project is being conducted in collaboration with twenty community groups, organizations, and government departments who have joined Heart Health Nova Scotia to form the Western Region Heart Health Partnership. The partners are engaged in all aspects of the research project and are committed to improving the heart health of Western area residents.

Defining Capacity for Heart Health

There is growing interest in enhancing organizational and community capacity to effectively implement and sustain community-based heart health programs. Increasing capacity for heart health at these levels may be the answer to the development of effective interventions that are appropriate for the environment and the population.

The Heart Health Partnership decided to focus on organizations as the primary unit of analysis and defined organizational capacity as, "the extent to which organizations within communities use and build upon their knowledge, skills, resources and abilities to take action on heart health". To develop the dimensions and indicators for capacity, partners were asked to respond to the following question: "What would an organization look like if it had capacity for heart health?". Information generated from their responses was grouped into three areas which became the dimensions of capacity. These dimensions are:
 

1. the existing programs and policies for heart health promotion;
2. the process for program/policy development, implementation and evaluation; and
3. the organizational environment within which heart health promoting activities occur.

Given the diverse mandates and organizational responsibilities of members on the Partnership, two strategies were developed that considered these differences and at the same time allowed for consistent and systematic data collection. Strategy One consists of three data collection methods to gather information on all three dimensions of capacity - a telephone survey, a self-administered questionnaire, and an interview. Strategy Two consists of key informant interviews and focus groups which explore the three dimensions of capacity.

The current report describes the results of the telephone survey within Strategy One. The survey results were entered into a database using EpiInfo. Frequency tables and charts were used to summarize the results that could be quantified and written descriptions were used to summarize responses to open ended questions.

Summary of Results

Data were collected from 182 respondents (sites) in 13 channels. These data were combined or aggregated to provide a picture of heart health involvement in the region. Of the 182 sites that responded to the survey, 65% were involved in tobacco related activities, 71% were involved in nutrition related activities, 47% were involved in physical activity promotion and/or programs, and 62% were involved in other heart health related activities such as stress reduction, blood pressure clinics and measurement, health fairs, etc. The majority of sites reported being somewhat involved in the above activities (35% to 58%), with fewer (12% to 21%) reporting being very involved.

Public education to raise awareness was the primary type of involvement in all four areas (tobacco, nutrition, physical activity and other heart health activities). This ranged from 90% for tobacco to 99% for other heart health activities. Public education to build skills was the next most common type of intervention and was reported by approximately half of the sites for each activity area. Enhancing environmental support was reported by about half of the sites for tobacco and physical activity, but was only mentioned 34% of the time for nutrition and 15% of the time for other heart health activities. Training for service providers was reported less often and ranged from 15 % for nutrition to 24% for physical activity. Generally respondents indicated low levels of involvement in policy change/advocacy, with most organizations involved approximately 15% of the time except for tobacco where organizations indicated they were involved 34% of the time.

Partnering occurred approximately one third of the time in all activity areas except in conducting other heart health initiatives where respondents indicated they worked with partners just over half of the time. These partnerships were generally cooperation (organizations retained ownership over their activities, but supported the work of others on an ad hoc basis) or collaboration (ownership for activities was shared, and organizations planned and implemented activities jointly). Ninety-one percent of the respondents stated that they would be willing to partner to promote heart health.

Approximately one quarter of organizations indicated involvement in health reform related activities. For the most part, this involvement consisted of consulting with or participating on local Community Health Boards.

Priority of heart health within each site was most often cited as medium (41%) followed by low (36%) and then high (22%).

Implications

This survey serves as an inventory of the type and level of involvement in heart health activities of 182 sites in 13 channels in the Western Health Region. It provides information on one dimension of capacity for the baseline data collection. The measurement of the remaining two dimensions of capacity is currently underway and involves face-to-face interviews, focus groups, and questionnaires. Information on all three dimensions will enable the Partnership to more appropriately select and plan strategies for the enhancement of heart health capacity in targeted organizations. For instance, the results of the current survey indicate that there is more involvement in tobacco, nutrition, and other heart health related activities than physical activity promotion programs across the region. In addition, most of the involvement in heart health promotion is in the area of public education to raise awareness. Although interventions to raise awareness are necessary and important activities, a comprehensive approach would also include public education to build skills, training for service providers, advocacy and policy change and enhancing environmental support. Planning efforts for the Partnership could be directed to these other, less well developed areas.

Even though most sites are not very involved in partnerships for heart health promotion at the present time, it is encouraging to note that almost all indicated they would be interested in pursuing this in the future. It is also noteworthy that the sites are familiar with the different ways in which partners can work together - i.e., coordination, cooperation and collaboration. All three relationships are important and appropriate and will be vital to the work of the Partnership as the project progresses.

Currently only 25% of the sites are involved in health reform activities. This will likely change as Community Health Boards seek opportunities and partners to implement their community health plans.

The Partnership is encouraged by the fact that 63% of the surveyed sites identified heart health as a medium to high priority for their channel. This is an excellent starting point for the Western Region Heart Health Partnership.

INTRODUCTION

This report describes the results of a telephone survey conducted in June 1997 with 13 channels in the Western Health Region of Nova Scotia. Each channel is comprised of 2 to 58 sites (e.g., groups, units, chapters, offices, etc.), with a total of 182 sites from the 13 channels responding to the survey. The purpose of the survey is to describe the type of heart health promotion activities that occurred in these channels. A separate report has been written for each channel in addition to this report showing aggregate results. The survey information will be combined with the results of other data collection methods (i.e. questionnaires, interviews, and focus groups) to provide a baseline of the existing capacity for heart health promotion among partners in the Western Health Region. Heart Health Nova Scotia is conducting this research as part of its Dissemination Research Phase. Capacity for existing heart health promotion programs and policies will be estimated again near the end of the research period in 2001.

Background

Heart Health Nova Scotia, a member of the Canadian Heart Health Initiative, is funded by the Nova Scotia Department of Health, and Health Canada via the National Health Research and Development Program (NHRDP). The Dissemination Research Phase is funded over a 5 year period, 1996-2001, and is being conducted in the Western Health Region of the province. This region encompasses 7 counties (Kings, Annapolis, Digby, Yarmouth, Shelburne, Queens, and Lunenburg) and has a population of approximately 211,000.

The dissemination research project is being conducted in collaboration with 20 community groups, organizations, and government departments who have joined Heart Health Nova Scotia to form the Western Region Heart Health Partnership. The partners are engaged in all aspects of the research project, and are committed to improving the heart health of Western Region area residents.
 

The program objective of the Heart Health Partnership is to develop and coordinate a system for supporting effective and sustained community-based heart health activities. In order to achieve this, organizations on the Partnership will reflect on the current status of their heart health promotion programs, policies, and partnerships to assess if there are areas where additional emphasis could be placed. In addition to these potential changes within Partnership organizations, community mobilization efforts will be undertaken in interested communities across the region. Organizations in the Partnership have committed to support these efforts by in-kind contributions of resources, both human and material, and by advocacy activities. Figure 2 graphically displays the structure, interrelationships, and outcomes within organizations and communities involved in the Heart Health Partnership Project.

Figure 2: The Heart Health Partnership Project - Structure

The purpose of the research is to investigate the dissemination of community-based heart health promotion and practice; and to improve our understanding of what inhibits or encourages the dissemination in the partner organizations and the communities they serve. The current context of health reform presents additional opportunities and challenges to consider.

To accomplish the research and program objectives, members of the Partnership have formed four working groups: Research, Community Activation, Knowledge and Skills, and Communication and Awareness. The Research Working Group is responsible for developing and measuring indicators related to heart health capacity within organizations, the process of community mobilization and partnership functioning; the Community Activation Working Group will seek to engage partner organizations and others at the local level and will facilitate the development of community heart health action teams and provide the necessary support these communities may require; the Knowledge and Skills Working Group will develop learning opportunities to build on the existing heart health capacity of partner organizations and community heart health action teams; and the Communication and Awareness Working Group will promote heart health and the work of the Heart Health Partnership throughout the Western Health Region.

Capacity for Heart Health - What Is It?

In light of evidence from community-based heart health promotion research projects (North Karelia, Stanford, Pawtucket, Minnesota), there is a growing interest in organizational and community capacity to effectively implement and manage community-based heart health programs. Evidence shows that interventions can increase awareness and change attitudes and behaviour to reduce the major risk factors for heart disease (physical inactivity, high fat diets, smoking). However, the momentum for change that is catalysed by research projects often dies once the research funding ends. Consequently, increasing the capacity for heart health promotion may be the answer to sustain effective interventions, and to develop or adapt timely interventions that are appropriate for the environment/conditions and the population. In other words, given the capacity to develop, adapt, implement and evaluate new and proven approaches, the likelihood of sustaining a given approach and intervention is greater particularly if part of the capacity includes strategies and skills to achieve sustainability.

The capacity for heart health can be described at various levels---individual, organization, and community. At the organization level, capacity can be described as the organization’s ability to implement strategies to reduce the risks of cardiovascular disease within a population. Nova Scotia’s Heart Health Partnership agreed on the following definition of capacity for this research.

Capacity--The extent to which organizations within communities use and build upon their knowledge, skills, resources and abilities to take action on heart health.

Given this definition, and the decision to focus on organizations as the primary unit of analysis, the following question was asked of the Partnership to put “capacity” in practical terms.

What would an organization look like if it had capacity for heart health?

The information that was generated from this question was grouped under three themes by the Research Working Group and became the dimensions of capacity. These dimensions are:

1. the existing programs and policies for heart health (i.e. what organizations are doing);
2. the process for program/policy development, implementation and evaluation (how they are conducting heart health promotion);
3. the organizational environment within which heart health promoting activities occur (why the organization participates in heart health promotion).

How will Capacity be Measured?

Currently there is variability of involvement in heart health promotion among Partnership organizations. Some organizations have a specific mandate for heart health while others wish to incorporate more heart health related activities into their goals. Therefore, two strategies have been developed for collecting the data. Both strategies collect information about all three dimensions of capacity - what, how, and why - however the methods being used vary depending on the needs of each organization. Figure 3 outlines the two data collection strategies.

Figure 3: Data Collection Strategy

Strategy One consists of three data collection methods: 1) a telephone survey which collects information about existing programs and policies; 2) a self-administered questionnaire which collects information about the process for program/policy development, implementation, and evaluation; and 3) an interview which collects further information about organizational practices/processes and the organizational environment that either supports or hinders heart health promotion activities.

Strategy Two consists of key informant interviews and focus groups which explore all three dimensions of capacity in selected organizations. This strategy is currently underway and a report will be available spring/summer 1998.

The current report offers information to describe the first dimension of capacity --existing programs and policies -- collected through the telephone survey outlined in Strategy One

Who Participated in the Survey

The telephone survey, which collected information related to existing programs and policies, was administered to five of the channels on the Partnership who were assumed to be the most involved in heart health related activities. These five channels included the Canadian Cancer Society units; Heart and Stroke Foundation chapters; Parks and Recreation departments; Public Health Services offices of the Western Regional Health Board; and branches of the Women’s Institutes of Nova Scotia. In consultation with Partnership members, it was determined that the telephone survey would not be appropriate for the other organizations on the Partnership. Instead, these organizations would participate in interviews where all three dimensions of capacity would be assessed (Strategy Two).

Eight additional channels, known to be involved in heart health activities, were added to the sample to give a more complete picture of heart health activities in the Western Region. Representatives from these channels were consulted to determine their involvement in heart health promotion. These organizations are not members of the Partnership, but it is anticipated that they will become involved at the community level. Table 1 lists the channels that participated in the telephone survey.

Table 1: Channels surveyed to inquire about heart health related activities