Health Promotion
in Primary Healthcare Settings
Dr. James Frankish, Senior Scholar
Director, Institute of Health Promotion Research
Associate Professor, Health Care & Epidemiology
& College for Interdisciplinary Studies
3X MacDonald’s Employee-of-the-Month
IHPR
Institute of Health Promotion
Research
Partners in Community Heath
Research-Training Program
Research Team & Collaborators

IHPR: J. Frankish, G. Moulton, D. Gray,
C. Cole, P. Stoesz

Co-Investigators: I. Rootman,
B. Zumbo, D. Wilson, M. Hills,
R. Lyons, M. Stewart

Advisory Committee: J. Besner,
S. Bosca, D. Butler-Jones, M. Carr,
P. McDonald, T. Mavor, G. Rentz,
N. Whyte

Health Canada, Health Transition
Fund, Canadian Consortium for Health
Promotion Research
Context & Rationale

Health promotion principles, practice & research have
benefited Canada

Much of primary healthcare is geared
toward community-centred health.
Health promotion is in provincial/
territorial mandates

Major reviews (Romanow,
Mazankowski, Kirby) have noted
that the health sector must toward
health promotion.

Governments have a mandate to
promote the health/quality
of life of Canadians.
A Continuum of Absurdities
Primary Healthcare is
Totally Responsible for
Health Promotion
There is No Role for Health
Promotion in Primary
Healthcare
What is the Preferred Future
for Health Promotion in
Primary Healthcare
in Canada?
Canadian Principles
of Primary Healthcare

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Patient involvement
Emphasis on keeping people
healthy
Appropriate, high quality
care
24-hour access to care
Individual choice of provider
Ongoing patient-provider
relationships
Clinical autonomy
Effective management
Affordability (Canadian Advisory
Committee on Health Services)
Methods

Literature Review

Preliminary Survey of
primary healthcare Settings

Document Compilation &
Review

IHPR-based Informants

Focus groups in Edmonton,
Halifax, Toronto & Vancouver
(45 participants)

Survey Questionnaire (webbased & hardcopy, sample of
523 primary healthcare sites)

22 Semi-structured Interviews
(Telephone)
National Web-Based Survey

Background & Demographics

Fit of
- Health Promotion Values
- Process-Related Characteristics
- Structural Characteristics
- Activities-Related Characteristics
- Outcomes-Related Characteristics

Intersectoral Collaboration for
Health Promotion

Factors Limiting Engagement in
Health Promotion

Reports of Data Collection re
Health Promotion
Types of Objects of Interest

Values

Process

Structure

Activities

Outcomes
Example - Values of Health Promotion
(% High Endorsement, > 6/7)

Adopting a broad view of health & its determinants 81%

Striving for optimal health/quality of life for staff/clients 91%

Empowering staff & clients 76%

Decreasing disparities for disadvantaged populations 70%

Sustaining human/natural resources for future 48%

Recognizing value/need for public participation in decisions about health
& quality of life issues 75%

Integrating different views of health & quality of life 64%

Being accountable (to staff, clients & the public) 81%
Example – “Process” Objects of Interest

Proactive Approach
- planning 54%
- implementation 42%
- evaluation 55%

Individualization & Choice 54%

Mutual Learning 52%

Respectful Communication 93%
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Meaningful Participation 64%
Example – “Structural” Objects of Interest
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Resource Allocation 75%
Committed Personnel 63%
Human Resources Development
(Capacity Building) 51%
Intersectoral Collaboration 72%
Accessibility 58%
Accountability 45%
Governance & Decision-Making 48%
Communication Channels 66%
Multidisciplinary Teams 65%
Organizational Culture 67%
Example – “Outcome” Objects of Interest

Outcomes at the Individual (Client/Community) Level
- Health status
- Lifestyle and/or health behaviours
- Health literacy
- Quality of life & well-being

Outcomes at the Organizational Level
- Health service effectiveness & efficiency
- Quality of work environment
- Accountability to clients & the public
- Inclusion of stakeholders in planning, implementation,evaluation

Outcomes at the Community Level
- Collaboration (within & across sectors)
- Healthful public policy
- Healthy environments (physical, economic & social)
- Social action, social capital
- Reduced health inequities
Standards of Acceptability

The second component of a criterion is
a "standard of acceptability." Objects of
interest must be judged against some
metric, scale or standard as to their
success or failure. Standard are dictated
by authority, custom or general consent.

Standards identify desired levels of
outcomes & allow people to agree on
how much should be achieved in return
for the investment of resources.

Standards should reflect improvement
in environmental, behavioral, social,
economic, health educational or policy,
organizational conditions. Standards
apply to program quality & outcomes.
Three Worlds of Planning
Public’s
perceived needs,
A
priorities
Arbitrary,
Experiential,
Community,
Utility Standards
“Actual
needs”
Resources,
feasibilities,
policy
Historical,
Scientific,
Normative
Standards
Propriety, Feasibility
Standards
From Green & Kreuter, 1991; Judd, Frankish & Moulton, 2001
Next Steps & Development of Resources

Reduce Number of Core
Characteristics & Pick
Indicators for Each

Identification of Partner
Demonstration Sites

Identification of Common &
Site-Specific Indicators

Funding & creation of adequate
data collection infrastructure
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Collection of data based on core
characteristics & indicators
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Consideration of working
indicators against standards
Contact Information
Dr. Jim Frankish, Senior Scholar, Michael Smith Foundation
Institute of Health Promotion Research
Rm 425, Library Processing Centre
2206 East Mall Vancouver BC V6T 1Z3
604-822-9205, 822-9210, frankish@interchange.ubc.ca
Personal Website: jimfrankish.com
BC Homelessness & Health Research – Network bchhrn.ihpr.ubc.ca
BC Homelessness Virtual Library - www.hvl.ihpr.ubc.ca
Partners in Community Health Research www.pchr.net
References

2007. Frankish J, Moulton G, Quantz D, Carson A, Casebeer
A, Eyles J, Labonte R, Evoy B. Addressing the non-medical
determinants of health: A survey of Canada’s health regions.
Canadian Journal of Public Health, 98(1):41-47.

2006. Frankish J, Moulton G, Rootman I, Cole C, Gray D.
Setting a Foundation - Values & Structures as a Foundation for
Health Promotion in Primary Health Care. Primary Health
Care Research & Development, 7 (2), 172-182.

2006. Moulton G, Frankish J, Rootman I, Cole C, Gray, D.
Building a Foundation: Strategies, Processes & Outcomes of
Health Promotion in Primary Health Care Settings, 7 (3), 269277.