Socio-Ecological Strategies for Chronic Disease Prevention & Management Research Interest Group
McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Education Quarterly1988 Winter; 15(4):351-77. |
Our Focus
|
Our Focus
Canadian policymakers have identified a need for supportive social infrastructures and safe, healthy communities that may prevent the development of chronic diseases and also improve the quality of life of individuals with chronic disease. This RIG aimed to clarify how to promote environments that support healthy living, how to develop strong links among community action groups and the academic community; and how to improve population-level outcomes by addressing the social determinants of health. Our five research themes were as follows: The built environment; ethnicity and chronic disease management and prevention; health literacy; knowledge dissemination and translation; and new roles and interprofessional/ intersectoral models of practice that will meet population health needs.
Our interdisciplinary research program was based on the socio-ecological theory of health promotion developed by McLeroy et al. (see Figure 1), which postulates that health-related behaviours are determined by five categories of factors: intrapersonal factors, interpersonal processes and primary groups, institutional factors, community factors, and public policy. The model predicts that efforts focused exclusively on the individual, at the expense of other factors are likely to fail. Thus, efforts to improve individuals’ health must be simultaneously directed at multiple levels. We suggest that the adoption of this broader socio-ecologic framework is required to underpin research and practice by acknowledging multiple influences on health behaviour, including local physical and social environments.
In addition to research and partnership building, a primary goal of the proposed RIG was the establishment of an accessible training program on chronic disease prevention and management. This training program built on RIG members’ national and international links with academics who are experienced with regard to Canada’s social safety net and chronic disease prevention and management. Our training incorporated Ryerson University’s expertise in providing continuing education to community and policy stakeholders engaged in helping vulnerable populations.
Given the considerable financial and public health burden of chronic disease in Canada and worldwide, it is critical to optimize the health of individuals living with a chronic disease and to prevent or delay future complications. Therefore, we have attempted to disseminate our findings broadly. Our results were disseminated to decision-makers and clinicians through meetings, reports, forums, community workshops, and professional organizations. We also used traditional methods of knowledge transfer, including hospital and university rounds, national and international conferences, and journal publications.
Investigators
- Chris Blanchard (Department of Medicine,
- Christine Maheu (
- Daniel Rainham (Department of Environmental Sciences,
- Dina Brooks (Physical Therapy,
- Enza Gucciardi, (School of Nutrition, Ryerson University)
- Gilbert Gallaher (Centre for Research on Inner City Health/ St. Michael’s Hospital)
- Guy Faulkner (Physical Education & Health, University of Toronto)
- Heather Beanlands (School of Nursing, Ryerson University)
- Margareth S. Zanchetta, (School of Nursing, Ryerson University)
- Dr. Maureen Dobbins (School of Nursing, McMaster University)
- Peter Wang (Division of Community Health and Humanities, Memorial University)
- Dr. Ron Buliung (Geography, University of Toronto at Mississauga)
- Souraya Sidani (School of Nursing, Ryerson University)
- Tony Cohn (Centre for Addiction and Mental Health)
- Victor Maddalena (Assistant Professor of Health Policy/Health Care Delivery, Memorial University)
- Yaping Jin (Dalla Lana School of Public Health, University of Toronto)
- Yanqing Yi (Division of Community Health and Humanities, Memorial University)
- Wendy Young (Community Health & Humanities and Nursing, Memorial University)
Partners
- Canadian Diabetes Association
- Cardiovascular & Pulmonary Health in Motion (
- Centre for Addiction and Mental Health (CAMH)
- Chang School, Ryerson University
-
- City of
- Daily Bread Food Bank
- Food Secure
- Halton Region Health Department
- Lakeridge Health Corporations
- Love & Live Life Cancer Care Services
- Mississauga Halton LHIN
- New Canadian Community Centre
- Ontario Ministry of Health & Long Term Care
- Seniors Resource Centre
- Southlake Regional Health Centre
-
- Support Network of Women
- Women’s Health in Women’s Hands
Seed Grant Project Descriptions
1. Barriers for Medical Care Utilization for Senior Chinese Immigrants
Principal Investigator (s):
Peter Wang (Division of Community Health and Humanities, Memorial University); Victor Maddalena (Assistant Professor of Health Policy/Health Care Delivery, Memorial University); Yaping Jin (Dalla Lana School of Public Health, University of Toronto); Yanqing Yi (Division of Community Health and Humanities, Memorial University); Wendy Young (Community Health & Humanities and Nursing, Memorial University)
Lead Community and/or Policy Partners:
New Canadian Community Centre
Description:
For the past 20 years, Canada has witnessed a changing demographic profile with an increasing number of Chinese immigrants settling in this country. According to the Statistics Canada, more than 650,000 Chinese immigrants (Mainland China, Hong Kong and Taiwan) came to Canada between 1980 and 2000. A large majority of the new Chinese immigrants live in major urban cities, such as Toronto and Vancouver. It is well recognized that Chinese immigrants in Canada are different from other Canadians in terms of their cultural beliefs and behaviors. Research suggests that most new immigrants lack basic knowledge about Canadian society and many do not have basic English communication skills. Elderly new Chinese immigrants are particularly vulnerable. Besides the challenges facing all new Chinese immigrants, elderly new Chinese immigrants often depend on the support from their children, and have very limited capacity and resources for adjustment. Despite cultural, religious, and lifestyle differences between Chinese immigrants and other Asian immigrants they are often treated as a homogenous group of Asian immigrants. Research in health conditions and health experiences of elderly new Chinese immigrants (ENCI) is limited and little is known about the barriers they may face in accessing health care.
The aim of this pilot study is to test critical operational and methodological aspects of a proposed larger study examining this population. Specifically, the pilot study will examine the efficiency of the proposed sampling and test the acceptability of the study in the target population (face validity). Preliminary results derived from the pilot study will also provide important information for developing a valid questionnaire, estimating sample size, and refining the costs for the proposed larger study. The pilot study will largely mimic the future larger population based study and will be conducted in 120 selected eligible subjects.
If the establishment of a full cohort study is shown to be feasible, the primary objectives of the proposed population based study will be to: 1) examine the health utilization patterns of ENCI; and 2) to develop understandings about the barriers that the elderly new Chinese immigrants experience when accessing health services. To achieve these objectives we will interview ENCI in the greater Toronto area (GTA) who have lived Canada less than 10 years.
Drawing on the WHO ICF conceptual framework, a mixed research design involving both qualitative and quantitative methods will be used. The results of the pilot study will effectively guide a larger population based study that will enhance the health and wellbeing of ENCI by reducing the barriers to accessing health facing this vulnerable population in Canada.
2. The Development of a Community-based Maintenance Exercise Program for Older Adults with Chronic Obstructive Pulmonary Disease
Principal Investigator:
Dina Brooks (Physical Therapy,
Lead Community and/or Policy Partners:
Parks and Recreation
City of
Description:
The goal of this research project is to develop and implement a supervised exercise program in a community setting for older adults with emphysema and chronic bronchitis. The supervised exercise program will contain elements common to respiratory rehabilitation programs in
Patients who have completed a program of respiratory rehabilitation will be referred to a community program which will consist of twice weekly exercise sessions given by a trained fitness instructor. We will conduct interviews with patients and fitness instructors to determine the structure of the program and develop educational material for fitness instructors and subjects.
3. ENvironmental Correlates Of caRdiac rEhabilitation (ENCORE)
Principal Investigator:
Chris Blanchard (Department of Medicine,
Lead Community and/or Policy Partners:
Cardiovascular & Pulmonary Health in Motion (
Description:
Research has shown that the environment (e.g., access to walking trails, community socioeconomic status (SES), etc...) is significantly associated with moderate to vigorous physical activity (MVPA) in non-diseased populations. Whether this is true for people living with heart disease remains unknown. Therefore, the present seed grant will shed light on this issue for patients attending cardiac rehabilitation (CR) in
4. Understanding and improving breast cancer self-management through social networks and infrastructures within Portuguese-speaking communities in
Principal Investigator:
Christine Maheu (
Lead Community and/or Policy Partners:
Love & Live Life Cancer Care Services
Description:
This study aims to explore the type of challenges, barriers, potential and the intentions of Portuguese speaking women who received a medical treatment for breast cancer to use services that may help them to care of themselves at home. We also intend to understand women’s particular ways to surviving breast cancer within their communities according to social and cultural norms. They may want to access, use, and neglect or refuse such services. People who do not live with the disease will also inform us about the way their communities understand and deal with breast cancer, social support, solidarity, and help. Moreover, with the help of our community partners, we will identify possibilities to create and consolidate new supportive networks, enhance communities’ capacity to provide culturally sensitive services to those women. Finally, we will inform about better collaboration among Breast Cancer Survivorship Program at
5. Health Literacy of Ethnic Seniors in St. John’s, NL
Principal Investigator:
Wendy Young (Community Health & Humanities and Nursing, Memorial University)
Lead Community and/or Policy Partners:
Seniors Resource Centre of Newfoundland and Labrador; the Newfoundland and Labrador – Health in Pluralistic Societies
Description:
Everyone hopes to stay active and healthy as they grow old. Unfortunately, many older adults do not have the health literacy skills they need to ensure their overall health and well being. Volunteers, community stakeholders and university members are hoping to change this situation for ethnic seniors in St. John’s Newfoundland, this committee will:
· Establish links with community organizations
· Obtain buy-in from these communities for research
· Work with community groups to have Canadian health literacy instruments translated
· Oversee the collection of baseline data on health literacy in St. John’s
· Assess the feasibility of submitting a grant to design, implement and evaluate culturally sensitive health literacy programs for ethnic seniors
Culturally sensitive health literacy programs will help ethnic seniors develop the skills they need to find, understand and communicate health information.
6. Dissecting the 'Obesogenic' Environment of CAMH Service Users: Clients' Perspectives
Principal Investigator(s):
Guy Faulkner (University of Toronto), Wendy Young (Memorial University)
Lead Community and/or Policy Partners:
the Centre for Addiction and Mental Health
Description:
Individuals with serious mental illness, such as schizophrenia, are at equal or greater risk for obesity than their age-matched counterparts. Although many behavioural and pharmacological strategies have had some success, it has been suggested an ecological approach would have a greater impact on reducing weight gain. The purpose of this study was to conduct interviews with Centre for Addiction and Mental Health (CAMH) clients and survivors to 1) identify and examine environmental factors in and around CAMH (Queen Street Facility) that may influence diet and physical activity in the inpatient housing setting and 2) develop participant oriented and directed interventions that promote healthy lifestyles amongst inpatient clients. With respect to the food environment, clients identified that CAMH contains many unhealthful dietary temptations. Clients said that the volume of unhealthful food available in the hospital made cravings particularly difficult to deal with. Additionally, factors such as stigma, low income, and limited privileges all contributed to what types of food clients purchased and where it was obtained. With respect to physical activity, clients identified that a lack of opportunity to be active was a primary reason activity levels were low amongst the clients. Some factors that related to a lack of opportunity included: a lack of privileges to leave the unit; confinement issues related to locked doors and staircases; a lack of physical activity programming; and inadequate exercise and physical activity facilities. To improve both diet and physical activity behaviours, clients mentioned that they would like to see a combination of not only intrapersonal interventions that would encourage and motivate them to be more healthful through an individualized care approach, but also environmental changes that would remove physical activity barriers and dietary temptations.
7. The Development of a Community-Designed Diabetes Self-Management Education Program for Women of Colour
Principal Investigator(s):
Enza Gucciardi (School of Nutrition, Ryerson University)
Lead Community and/or Policy Partners:
Women’s Health in Women’s Hands
Description:
The proposed research consists of two systematic literature reviews focusing on barriers and facilitators to diabetes self-management and access to/participation in diabetes self-management education (DSME) programs for women of colour. These barriers have been identified as possible limiting factors impeding diabetes self-management knowledge and DSME program attendance. The target study population is composed of women with Type II Diabetes Mellitus who have a Black African/ Caribbean, Latin American or South Asian ethnic background. Women and people from these specific cultural groups are identified as having an increased risk and vulnerability to diabetes and its related complications, as well as limited achievements in effective diabetes self-management. This study uses an intensive systematic literature review methodology to discover common barriers within these groups. The ultimate goal of this study is to develop and implement an improved and more effective DSME program for our target population in collaboration with a community partner
Additional RIG Projects
- Developing and Testing an Innovative Methodology to Evaluate Community Capacity Building and Action:
- Healthy Weights: Halton Takes Action
- Evaluation of the implementation of the Blue Print for Action of the Halton Active Living Network (HALNet)
- Cultural/Racial Differences in Diabetes Preventative Care Practices in Canada
- Food Insecurity in Canadians with Diabetes Mellitus
- The Development of an Intervention to Promote Psychological Wellbeing Across Three Distinct Illness Populations
- Families of Diverse Ethno-cultural Backgrounds Living in a Minority Linguistic Context: Exploring the Construction of Families’ Health Literacy
- Cultural and Gender Perspectives about Self-monitoring of Blood Glucose in Non-insulin or Non-anti-glycemic treated Individuals with Diabetes
- Effective Delivery of Diabetes Self-management Education Programs
- Built Environment and Active Transportation
- Aging at Home
- Dissecting the 'obesogenic' environment of CAMH service users: Clients' perspectives
- The Development of a Community-Designed Diabetes Self-Management Education Program for Women of Colour
- Developing and Testing an Innovative Methodology to Evaluate
- Tackling Health Impacts from Urban Air Pollution
- Broadband Technology and Metropolitan Sustainability
- Working late: strategies to enhance productive and healthy environments for the older workforce – the Canadian context
- Critical Awareness of Health Literacy among French Speaking Health and Social Services Workers
RIG Student Awards
- Jennifer Boyko (PhD Candidate, Health Research Methodology, Department of Clinical Epidemiology and Biostatistics,
2009 Chronic Disease RIG Graduate Student Fellowship Recipient
Project title: “Deliberative Dialogues as a Mechanism for Knowledge Translation”
Jennifer is currently in her third year of a PhD in Health Research Methodology in the Department of Clinical Epidemiology and Biostatistics at
-
2009 Chronic Disease RIG Graduate Student Fellowship Recipient
Project title:“Provincial Wellness Grant Proposal”
Past RIG Events
The RIG is pleased to announce that over the 2009-2010 academic year, we piloted two RIG Fireside Chats on chronic disease prevention and management, developed and guided by a group of graduate students through the use of an innovative virtual networking venue.
Hosted by the Population Health Improvement Network at the University of Ottawa, CHNET-Works! is an evolving infrastructure, using innovative information technology to help support discussions and actions on pressing community health issues. This networking venu is dedicated to bringing together community health professionals from across
The first Fireside Chat was held on November 27th, 2009 and examined policy implications of 'Built Environment' and healthy lifestyle choices for the prevention of chronic disease. Sixty-five participants from across Canada tuned in to hear Wendy Young present research from a project entitled, "Healthy Weights: Takes Action" followed by Stephen Samis, who discussed how research on the built environment and physical activity is influencing current and future policies at the Heart and Stroke Foundation of Canada. The unique technological platform of the Fireside Chat encouraged text and voice discussions from the pan-Canadian participants, and also permitted the sharing of relevant online resources and electronic files. It was a tremendous opportunity for the grad students to guide the process, access expertise from other jurisdictions and have the opportunity to share their own research insights.
Following the success of their first national Fireside Chat this fall, student members of the Socio-Ecological Strategies for Chronic Disease Prevention and Management RIG hosted their second chat on June 4th, 2010. This Chat showcased student research in the topic area of Socio-Cultural Influences of Physical Activity.
Participation and registration for the RIG Fireside Chats is free of charge and we encourage anyone who is interested to participate.
For more information on CHNET-Works! and Fireside Chats, please visit: www.chnet-works.ca