Once the channels were selected, arrangements were made to contact individuals to respond to the questionnaire. Lists of contacts were assembled with the help of representatives from organizations and professional associations--e.g. the Medical Society provided a list of family physicians, and the Nova Scotia Pharmacy Association provided a list of pharmacies and contacts.

An abbreviated copy of the questionnaire was sent with a letter and a brief description of the project to each individual to be surveyed in the channels noted in Table 1 except for physicians and pharmacists. The physicians survey was a unique self-administered mail survey. The pharmacists survey was similar to the other channels, but no information was sent prior to the phone calls.

Five members of the heart health staff conducted the telephone interviews. All staff were trained prior to data collection and met frequently as the interviews were progressing to ensure consistency in interpretation of responses and data collection procedures. Telephone calls were made to contacts to set-up an interview appointment. Interviews began in May, 1997 and extended into June. The average time to complete the interview was 20 minutes. While some of the channel representatives believed that some of the questions were not applicable to their work, they were encouraged to respond to these questions in the best way they could. In addition to the interview, recreation departments were asked to send copies of their activity brochures and schedules. This information will be useful for more detailed analysis at a later date.

The survey results were entered into a database using EpiInfo, a data entry and analysis package for calculating frequencies and other meaningful statistics. 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.

RESULTS - A REGIONAL VIEW

Overview

This report is the first in a series to describe organizational capacity for heart health. This report provides an estimate of heart health related activities in selected organizations, or channels, in the Western Health Region. The data were combined and summarized to provide a regional view of involvement in heart health related activities. This was useful to 1) show the distribution of communities where organizations were surveyed about their involvement with heart health, and 2) report an estimate of the level of involvement in each risk area (tobacco, nutrition, physical activity, and other heart health activities) overall. When reviewing these results, it is important to keep in mind that these data represent a select group of channels chosen for this study, and that the channels are diverse in the resources they dedicate to heart health related activities. Therefore, expressions of involvement in specific heart health related activities are viewed relative to the individual channels, and should not necessarily be viewed as similar levels of involvement across channels. Despite this limitation, the information will ultimately contribute to decisions about dissemination of heart health promotion in the region.

Table 2 shows the number of surveyed sites and number of communities distributed by county. Kings and Lunenburg counties have the greatest number of surveyed sites. Figure 4 shows the seven counties within the Western Health Region, and the distribution of communities where one or more channels were surveyed about their involvement in heart health related activities. The community location symbols are colour coded to show the distribution by Community Health Board (CHB) area, a subdivision determined during the recent health reform activities in Nova Scotia. Except for Digby County and Kings County, the County and CHB areas have the same boundaries. Digby County is divided into two CHB areas (Clare and Digby), and Kings County is divided into four CHB areas (Eastern Kings, Central Kings, Western Kings, and Kingston-Greenwood). The map shows that channels were surveyed in each of the seven counties, and each of the eleven CHB areas. Again, the data for this display includes the community locations of channels listed in Table 1.

Table 2: Number of Surveyed Sites and Communities by County

Involvement in Heart Health Related Activities

Considering the region as a whole, and the 182 representatives from the 13 channels 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. (see Table 3).
 

Table 3: Involvement in Heart Health Related Activities

Tobacco Related Activities

From the 13 channels, one hundred and eighteen (65%) sites reported being involved in tobacco related activities. Figure 5 illustrates the level of involvement in tobacco related activities. Table 4 shows categories that describe the types of involvement, and ratings of the level of involvement for each category. Ninety percent were involved in public education to raise awareness, 54% were involved in public education to build skills, 17% were involved in training for service providers, 34% were involved in policy change/advocacy, and 50% were involved in enhancing environmental support. As shown in Table 5, the percentage of sites involved in school, work, and health care settings was similar (approximately 30%), less in recreation settings (19%), and more in the general community (40%). The sites that reported being very involved in tobacco related activities were doing so primarily in school settings.

Figure 5: Level of Involvement in Tobacco Related Activities
 
 

Table 4: Level of Involvement in Tobacco Related Activities

Table 5: Involvement in Tobacco Related Activities in Specific Settings

Nutrition Related Activities

One hundred and twenty eight (71%) respondents reported being involved in nutrition related activities. Figure 6 shows the level of involvement in nutrition related activities. As shown in Table 6, 95% were involved in public education to raise awareness, 57% were involved in public education to build skills, 15% were involved in training for service providers, 16% were involved in policy change/advocacy, and 34% were involved in enhancing environmental support. A greater percentage of sites reported being involved in general community settings compared to the other settings listed; and those reporting being very involved with nutrition related activities were primarily involved in school and general community settings (Table 7).

Figure 6: Level of Involvement in Nutrition Related Activities
 
 
 

Table 6: Level of Involvement in Nutrition Related Activities

Table 7: Involvement in Nutrition Related Activities in Specific Settings

Physical Activity Related Activities

Figure 7 illustrates the level of involvement in physical activity programs and promotion for the 182 sites. Eighty-five (47%) respondents reported being involved in physical activity related programs and promotion. Ninety three percent were involved in public education to raise awareness, 54% were involved in public education to build skills, 24% were involved in training for service providers, 18% were involved in policy change/advocacy, and 46% were involved in enhancing environmental support (Table 8). Physical activity related programs and promotion were occurring most often in general community settings, recreation, and school settings. Table 9 shows that those who were very involved in physical activity indicated recreation and general community settings most often, followed by school settings.

Figure 7: Level of Involvement in Physical Activity Programs and Promotion
 
 
 

Table 8: Level of Involvement in Physical Activity Related Activities

Table 9: Involvement in Physical Activity Related Activities in Specific Settings

Other Heart Health Related Activities

One hundred and fifteen (62%) respondents reported being involved in other heart health related activities (e.g., stress reduction, blood pressure, health fairs, etc.). Figure 8 shows the level of involvement in other heart health related activities. Table 10 shows that 99% were involved in public education to raise awareness, 60% were involved in public education to build skills, 22% were involved in training for service providers, 14% were involved in policy change/advocacy, and 15% were involved in enhancing environmental support. General community, health care, and school settings were identified as areas where other heart health related activities occurred. The sites who were very involved in other heart health related activities indicated general community and school settings most often (Table 11).

Figure 8: Level of Involvement in Other Heart Health Related Activitie
 
 
 

Table 10: Level of Involvement in Other Heart Health Related Activities

Table 11: Involvement in Other Heart Health Related Activities in Specific Settings

Partnering

Respondents were asked about working with partners. Table 12 shows the number and percentage of respondents who indicated their site worked with partners in heart health related activities. These are shown for each risk factor area.

In the area of tobacco related activities, 27% of respondents indicated working with one or more partners. The nature of the partnerships were mainly cooperative (43%) and collaborative (40%). Cooperative partnerships are characterized by a relatively small amount of partner interaction, and collaborative partnerships are characterized by the greatest amount of partner interaction to implement activities. When asked if the Department of Health played a role, 40% indicated that they played a lead role (18%) or a support role (22%).

In the area of nutrition, 30% of respondents implemented activities with partners. Again, the types of partnership were a split between cooperative (41%) and collaborative (40%). Similar to involvement in tobacco related activities, the Department of Health played a lead role (14%) or support role (29%) in nutrition related activities.

In the area of physical activity, 40% of respondents participated in activities with partners. The nature of the partnerships was mainly cooperative (53%) or collaborative (35%). Again, the role of the Department of Health was more in the area of support (26%) than lead (16%) in physical activity programs and/or promotion.

In the area of other heart health related activities, 51% of respondents indicated working with partners. Once again, the nature of the partnerships was mainly cooperative (45%), followed by collaborative (36%). The role of the Department of Health was most often supportive (28%).

Overall, 91% of sites stated they were willing to work in partnership to promote heart health in the Region.

Table 12: Partnering with Other Organizations or Community Groups

Cooperation: organizations retained ownership over their activities, but supported the work of others on an ad hoc basis (for example sharing ideas and information as needed)
Co-ordination: organizations retained ownership over their activities, but a process was in place to share plans to avoid duplication.
Collaboration: ownership for activities was shared, and organizations planned and implemented activities jointly

Priority of Heart Health

Assuming respondents understood “heart health” and some of its defining characteristics, they were asked to rate the priority of heart health for their site. Table 13 shows that 36% rated heart health as a low priority, 41% rated it a medium priority, and 22% rated heart health as a high priority.

Table 13: Frequency of Priority Rating of Heart Health

Health Reform

Table 14 shows that forty-two (25%) sites indicated they were involved in health reform activities. For the most part, this involvement consisted of consulting with or participating on local Community Health Boards (CHBs). Some sites gave presentations to CHBs. Members of one group also attended meetings which addressed the impact health reform could have on their organization. Two sites indicated that they were involved in needs assessments within local communities in conjunction with the CHB.

Table 14: Involvement in Health Reform

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 our 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 presently work with partners in a variety of ways - 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 should be 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.

Survey Limitations

This telephone survey measured only one of three dimensions of heart health capacity for 13 channels in the Western Region. Therefore, results of the current survey should not be used in isolation to describe organizational capacity. A more complete picture of organizational capacity for heart health promotion in selected channels will be available in the spring of 1998, once information on the remaining two dimensions has been collected and analysed.

Channels for the survey were chosen purposefully, and were selected based on their mandate and areas of responsibility within health promotion, and specifically heart health promotion. While an attempt was made to include all relevant channels, it is possible that some may have been overlooked.