Health Promotion Capacity Building Research Articles

Community Capacity Building for Health Promotion: Lessons from a Regional Australian Initiative

This paper discusses a health promotion intervention that sets out to develop local capacity to address chronic disease risk factors in a remote Australian community. Community focus groups, and researcher and community discussions, aimed to determine the community's health concerns and build a partnership for community action. The journey from conception to reality was difficult for a number of reasons that are described here. Despite these difficulties, a range of outcomes included the establishment of an organisational structure that involved a local health promotion committee as the principal decision-maker, the establishment of a grants scheme to support locally determined initiatives and the formal incorporation of a community Health Promotion Committee (HPC) that ensured the sustainability of activities beyond the funded project period. The HPC is still coordinating health promotion activities. The promotion of community ownership of health promotion activities is a complicated process, given that time, resources, expertise and community involvement require a much longer-term commitment than that currently imposed by many funding bodies.

Research as Intervention in Heart Health Promotion

Capacity building in health promotion has traditionally involved training interventions to support knowledge, skill and resource building for effective practice. However, there is a need to understand how research can be used to support capacity building and practice. Findings are based on a parallel case study comprising qualitative analysis of 66 key informant interviews from five provincial heart health projects (Manitoba, Prince Edward Island, Ontario, Saskatchewan, and Newfoundland and Labrador) as part of the Canadian Heart Health Dissemination Project. Results indicate research was used primarily to monitor and report results about health promotion capacity and dissemination to stakeholders, and contribute to participatory processes. Respondents noted that research as intervention had an influence on five areas of health promotion capacity and practice: increased heart health promotion knowledge/skills; improved programming, planning and prioritizing; increased motivation for (heart) health promotion initiatives; and cultivation of relationships as well as buy-in. Research was a complementary capacity-building activity, although it did not directly increase program implementation. These findings contribute to linking researchers, practitioners and community decision-makers in the process of enhancing health promotion practice.

Developing and Implementing a Triangulation Protocol for Qualitative Health Research

In this article, the authors present an empirical example of triangulation in qualitative health research. The Canadian Heart Health Dissemination Project (CHHDP) involves a national examination of capacity building and dissemination undertaken within a series of provincial dissemination projects. The Project's focus is on the context, processes, and impacts of health promotion capacity building and dissemination. The authors collected qualitative data within a parallel-case study design using key informant interviews as well as document analysis. Given the range of qualitative data sets used, it is essential to triangulate the data to address completeness, convergence, and dissonance of key themes. Although one finds no shortage of admonitions in the literature that it must be done, there is little guidance with respect to operationalizing a triangulation process. Consequently, the authors are feeling their way through the process, using this opportunity to develop, implement, and reflect on a triangulation protocol.

Using linking systems to build capacity and enhance dissemination in heart health promotion: a Canadian multiple-case study

The purpose of this paper is to examine the utility of linking systems between public health resource and user organizations for health promotion dissemination and capacity building, and to identify factors related to the success of linking systems. The design is a parallel-case study using key informant interviews and content analysis of project reports (synthesized qualitative and quantitative data) of three provincial dissemination projects of the Canadian Heart Health Initiative-Dissemination Phase. Each provincial project used linking activities with public health user groups including meetings, skill building, resources, collaboration, networking and research feedback to facilitate capacity building for and implementation of heart health promotion activities. This paper presents empirical examples of linking system designs, activities, and qualitative and quantitative changes in the public health user groups' health promotion capacity, program delivery and sustainability. The findings indicate enhanced health promotion skills, partnerships, resources, infrastructure, and increased programming and sustainability in the targeted public health organizations of all three provincial projects. Identified barriers to the success of linking systems included lack of appropriately skilled personnel, funds, buy-in and leadership. We conclude that linking systems can be flexibly used to build capacity and disseminate health promotion innovations, and suggest conditions for success.

Defining and operationalizing capacity for heart health promotion in Nova Scotia, Canada.

This paper presents an operational definition of capacity building for heart health promotion, instruments developed to measure heart health capacity, and baseline results of capacity for 20 organizations. Qualitative and quantitative research methods were used to collect data. Three instruments were developed to measure organizational capacity for heart health promotion: a survey of community agencies involved in heart health, a questionnaire of organizational practices supportive of heart health promotion, and an interview guide that focused on factors influencing heart health promotion. These instruments proved effective and informed the development of a comprehensive framework for heart health promotion.

Editorial – Leadership development in health promotion

Introduction: Is leadership development just a trendy catchphrase for something that is already commonplace? My view is that active support for the development of leaders at different levels within organisations and among communities has been rare. By focusing on leadership development, we can move from an ad hoc situation to a more sustained approach that will be consistent with the latest thinking on capacity building in health promotion.

Reorienting health services with capacity building: a case study of the Core Skills in Health Promotion Project.

This paper presents a case study of the application of a framework for capacity building [Hawe, P., King, L., Noort, M., Jordens, C. and Lloyd, B. (2000) Indicators to Help with Capacity Building in Health Promotion. NSW Health, Sydney] to describe actions aimed at building organizational support for health promotion within an area health service in New South Wales, Australia. The Core Skills in Health Promotion Project (CSHPP) arose from an investigation which reported that participants of a health promotion training course had increased health promotion skills but that they lacked the support to apply their skills in the workplace. The project was action-research based. It investigated and facilitated the implementation of a range of initiatives to support community health staff to apply a more preventive approach in their practice and it contributed to the establishment of new organizational structures for health promotion. An evaluation was undertaken 4 years after the CSHPP was established, and 2 years after it had submitted its final report. Interviews with senior managers, document analysis of written reports, and focus groups with middle managers and service delivery staff were undertaken. Change was achieved in the three dimensions of health infrastructure, program maintenance and problem solving capacity of the organization. It was identified that the critically important elements in achieving the aims of the project-partnership, leadership and commitment-were also key elements of the capacity building framework. This case study provides a practical example of the usefulness of the capacity building framework in orienting health services to be supportive of health promotion.

Capacity building in health promotion, Part 2: whose use? And with what measurement?

Capacity building has been a topic in health promotion literature for several years. In our previous article, we discussed community capacity building as both means and end in health promotion work, and reviewed seven theoretical and empirical models of community capacity which provide a total of nine separate capacity domains. In this article we discuss the parallel tracking of community capacity building in health-promotion program planning, implementation and evaluation, and describe workshop methodologies for incorporating capacity assessments within health-promotion program planning. We conclude with a discussion of measurement options for community capacity building.

Capacity building in health promotion, Part 2: Whose use? And with what measurement?

Capacity building has been a topic in health promotion literature for several years. In our previous article, we discussed community capacity building as both means and end in health promotion work, and reviewed seven theoretical and empirical models of community capacity which provide a total of nine separate capacity domains. In this article we discuss the parallel tracking of community capacity building in health-promotion program planning, implementation and evaluation, and describe workshop methodologies for incorporating capacity assessments within health-promotion program planning. We conclude with a discussion of measurement options for community capacity building.

Capacity building in health promotion, Part 1: for whom? And for what purpose?

Capacity building in health promotion, Part 1: for whom? And for what purpose?

Capacity building in health promotion, Part 1: For whom? And for what purpose?

Capacity building has been a topic in health promotion literature for several years. Similar constructs that preceded it include community development and community empowerment. More recent constructs, notably social capital and social cohesion, make roughly similar claims on the same social space. This space essentially describes elements of peoples' day-to-day relationships, conditioned and constrained by economic and political practices, that are important determinants of the quality of their lives, and of communities' healthy functioning. In this paper, we discuss capacity building as health promotion means (its instrumental value to other goals) and end (constitutive of the type of human development health promotion espouses). We describe three different uses of the term capacity building and distinguish community capacity indicators from two other types pertinent to health promotion program evaluation: population health indicators, and program-specific indicators. We review seven theoretical and empirical models of community capacity, which provide a total of nine separate capacity domains. A second article in this series takes up issues of community capacity use and measurement in health promotion planning and evaluation.

Working Invisibly: Health Workers Talk About Capacity-Building in Health Promotion

SUMMARY A series of six focus groups was held with health promotion workers to explore the meaning and experience of ‘capacity-building’, a term which is used variously in the literature. The research is part of a participatory, practice-based project to develop outcome indicators in capacity-building. Capacity-building was defined as seeking to develop health promotion skills and resources, and also problem-solving capability, at five levels: the individual; within health care teams; within health organisations; across organisations; and within the community. While workers had little difficulty in identifying outcomes of capacity-building, indicators of quality or good process were more difficult to articulate. This was partly because capacity-building was described as an invisible, even secret process. Capacitybuilding is hidden from funders and administrators because it is not generally regarded as a legitimate project activity; that is, it is not directly linked to risk factor behaviours in priority areas such as cancer, heart disease and injury control. Capacity-building is also hidden from other workers in order to make it more effective. This is particularly the case with health promotion workers working within what they perceive to be hostile climates, such as health care settings experiencing funding cut backs. The invisibility of practitioners’ capacity-building work has implications for quality control, guiding theory, practice ethics, peer support, worker morale and funding mechanisms in health promotion.