A Process for Determining Best Practices in Aboriginal Population Health Programming

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A Process for Determining Best Practices in
Aboriginal Population Health Programming
Service Delivery in Alberta Regional Health
Authorities

• Edmonton, Alberta
• November 15, 2007
• Marcy Burka-Charles, MSc.
• Brett Hodson, MSc.

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Acknowledgement

• This geographic area to be the traditional
  territory of Cree Nations
• Alexander First Nation
• Alexis First Nation
• Enoch Cree Nation
• Paul First Nation

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cont. Acknowledgement

• Funding Agency
• Aboriginal Health Strategy Project Fund (AHSPF),
  Alberta Health and Wellness (AHW)
• Steering Committee
• Phil Burke (AHW)
• Lorraine Deschambeau (Aspen Health Region)
• Brett Hodson (Calgary Health Region)
• Malcolm King (ACADRE, University of Alberta)
• Barb Olsen Tracy Lee (DTHR)
• Karoline Phillip (Chinook Health Region)
• Adrienne Wiebe (Capital Health Region)

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Presentation Overview

• Context
• Aboriginal Health Strategy Project Fund (AHSPF)
• Best Practices in Aboriginal Health Programming
  Project
• Project Activities
• Preliminary Findings

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Context - AHSPF

• Inception 1996 2005
• Funding Term 1-3 years
• Funding Principles
• Collaborative, innovative, community-based
  projects
• Culturally sensitive
• Effective community participation in the
  planning, design, and administration of health
  services

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Context - Best Practice Project

• Funder AHSPF
• Partners
• 6 RHAs
• University of Calgary
• Steering Committee
• Primarily RHA representatives
• Guided project activities

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cont. Context

• Project Objectives
• Establish a base-line inventory of best
  practices
• Assess effectiveness of RHA funded projects
  (1999 2005)
• Findings
• Advise RHAs of best, smart, or promising
  practice criteria and/or processes
• Inform future research agenda

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Project Activities
Literature Review(n 50 periodicals 50
non-periodicals)
Inventory(n 82)
Model Consensus
Document Review (n 20)
Focus Group Discussions (n 5)
Forum (Spring 2008)
Final Report
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Literature Review

• No universally accepted definition of a best
  practice
• Context specific and value laden
• Diverse definitions ? diverse applications
• A best practice tends to be
• A strategy, activity, approach, or program found
  to be effective through research, evaluation,
  and/or experience
• Often driven by a western, euro-centric form of
  knowledge

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cont. Literature Review

• Best practice models reviewed were
• Primarily concentric and non-static
• Process deemed as important as the outcomes
• Over-generalized
• Most omitted culture and spirituality as a key
  attributes
• Western science over indigenous science

Ideology
Process
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Document Review

• Model Applied Better Practice Model
• Developer Cameron et al (2001)
• No best practice, only better practice
• The full range of activities and processes
  carried out vigilantly that are associated with
  developing or identifying, implementing,
  evaluating, and improving interventions aimed at
  improving health outcomes
• Represents ongoing reflection and improvement
  through a dynamic, interactive, evolutionary
  cycle
• Recognizes contributions of current practice and
  experience, valuing context-specific
  decision-making

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Better Practice Model
Source Cameron R et al (2001). Linking science
and practice Toward a system for enabling
communities to adopt best practices for chronic
disease prevention. Health Promotion Practice, 2,
35-42.
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cont. Better Practice Model
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Phase I Key Steps

• Definition of scope involves describing
• subjects
• targeted change
• information sources
• databases
• focus group discussions
• forum
• methods of extracting information
• models or frameworks

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cont. Phase I Key Steps

• A review of the evidence involved an assessment
  of
• Literature Review
• Document Review
• Focus Group Discussions

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cont. Phase I Key Steps

• Analysis of the evidence involved an assessment
  of
• Effectiveness
• Plausibility
• Practicality

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Effectiveness

• Literature review limitations
• No-intersectoral examples
• No follow-up initiatives or research
• No recommended
• best practice models or assessment tool
• concise list of best practice criteria
• Solution
• Seek examples of best/better practice from
  document review then cross-check with published
  and unpublished literature sources

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Plausibility

• Evaluation
• Process
• Formative/pilot
• Content
• Observed intervention approach (e.g., primary
  health care, population health, or health
  promotion)

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Practicality

• Process
• Collaborative approach, visibility,
  sustainability, community-led support, outreach,
  mobilizes community resources, competing
  programs, and community needs/wants
• Other
• time-sensitivity, replicability,
  generalizability, and cultural accessibility

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cont. Phase I Key Steps

• Forming recommendations associated to
• Practice
• Research
• Tools
• A democratic process among steering committee
  members.

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Preliminary Findings

• Document Review (n20)
• All projects were evaluated (external)
• Interventions
• Hospital based
• Primary health care
• Health promotion
• Information gap
• Determination of need
• Cultural Accessibility (language and traditions)
• Sustainability
• Focus group discussion questions were based on
  information gap

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cont. Preliminary Findings

• Focus Group Discussions (n 5)
• Need for program/service often identified by
  the community
• The Great Divide
• Western and Indigenous health ideologies
  different science and approaches
• Incorporating Indigenous culture and traditions ?
  Aboriginal peoples acceptance of service/program
  offered
• Respectful relationships and partnerships are
  essential to sustaining project activities
• Aboriginal liaisons
• RHA gatekeepers to Aboriginal communities

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Thank You!