Biomedical subjects

John Eyles

Publications and source records attributed to John Eyles.

At least 19 recordsLinked to original sources

PubMed2006

Understanding facilitators of and barriers to health promotion practice.

The health promotion best practices literature is imbued with hope for knowledge mobilization, enhanced practice, and improved population health. Given constrained medical care systems, health promotion is key to reducing the significant burden of chronic disease. However, we have seen little evidence of change. This article investigates facilitators of, and barriers to, three stages of health promotion practice in public health organizations, interagency coalitions, and volunteer committees. The article focuses not on what works but why it does or does not, drawing on five case studies within the Canadian Heart Health Initiative. Results indicate that the presence or absence of appropriately committed and/or skilled people, funds and/or resources, and priority and/or interest are the most common factors affecting all stages of health promotion practice. The article extends the literature on internal and external factors affecting health promotion and highlights strategic influences to consider in support of effective health promotion practice.

Canada↗

PubMed2006

Relationships between community characteristics and municipal smoke-free bylaw status and strength.

BACKGROUND: Municipal smoke-free spaces bylaws are a common population-level intervention to address the prominent health risks associated with exposure to second-hand smoke. In Canada, bylaw prevalence is increasing, but inequities in level of protection across communities remain as bylaws vary from place to place. Little is known about the role of place in this policy disparity. To address this gap, this study examined associations between community characteristics and municipal smoke-free spaces policy outcomes to elucidate how ecological conditions are associated with bylaw status and strength. METHOD: Smoke-free public place and workplace bylaws were obtained from all municipalities with a population of >or=5000 in the provinces of Alberta (N=78) and Ontario (N=245), Canada. Bylaws were assigned a strength score (ranging 0-100) rating the degree of bylaw comprehensiveness, restrictiveness and enforcement provisions. These data were then linked to socio-demographic data from the Canadian Census (1996) and the Canadian Community Health Survey Cycle 1.1 (2000/2001). Logistic and multiple linear regression analyses were used to develop models for municipal bylaw status and strength using community factors including: socio-demographics, municipality type, health region smoking rates, and provincial tobacco control environment. CONCLUSIONS: Study findings suggest that community characteristics play a key role in the status and strength of municipal smoke-free bylaws. As smoking bans continue to emerge world-wide under the Framework Convention on Tobacco Control, knowledge about conditions that promote policy success will be critical for those in need of immediate information to maximize policy-making in their own settings. Use of community profiles that consider socio-demographics along with broader contextual factors can aid decision-makers, public health advocates, and researchers in identifying similar jurisdictions with a successful smoke-free spaces policy and communicating with them about their policy-making experiences. Knowledge about the conditions associated with municipal policy-development may be translated to other jurisdictions where information is sparse, or evidence is newly emerging.

Alberta↗

PubMed2006

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.

Canada↗

PubMed2005

Inequalities in neighbourhood socioeconomic characteristics: potential evidence-base for neighbourhood health planning.

BACKGROUND: Population health planning aims to improve the health of the entire population and to reduce health inequities among population groups. Socioeconomic factors are increasingly being recognized as major determinants of many aspects of health and causes of health inequities. Knowledge of socioeconomic characteristics of neighbourhoods is necessary to identify their unique health needs and enhance identification of socioeconomically disadvantaged populations. Careful integration of this knowledge into health planning activities is necessary to ensure that health planning and service provision are tailored to unique neighbourhood population health needs. In this study, we identify unique neighbourhood socioeconomic characteristics and classify the neighbourhoods based on these characteristics. Principal components analysis (PCA) of 18 socioeconomic variables was used to identify the principal components explaining most of the variation in socioeconomic characteristics across the neighbourhoods. Cluster analysis was used to classify neighbourhoods based on their socioeconomic characteristics. RESULTS: Results of the PCA and cluster analysis were similar but the latter were more objective and easier to interpret. Five neighbourhood types with distinguishing socioeconomic and demographic characteristics were identified. The methodology provides a more complete picture of the neighbourhood socioeconomic characteristics than when a single variable (e.g. income) is used to classify neighbourhoods. CONCLUSION: Cluster analysis is useful for generating neighbourhood population socioeconomic and demographic characteristics that can be useful in guiding neighbourhood health planning and service provision. This study is the first of a series of studies designed to investigate health inequalities at the neighbourhood level with a view to providing evidence-base for health planners, service providers and policy makers to help address health inequity issues at the neighbourhood level. Subsequent studies will investigate inequalities in health outcomes both within and across the neighbourhood types identified in the current study.

Journal Article↗

PubMed2005

"Unless you went in with your head under your arm": patient perceptions of emergency room visits.

There is increasing concern in Canada regarding growing pressures on emergency room care. Frequent media reports call attention to overcrowding, lengthy waiting times and the re-routing of ambulances due to the closure of emergency rooms during periods of overcrowding. Much of this information, however, is anecdotal. As such, little is known about patients' experiences in emergency rooms in Canada. The purpose of this study is to explore patients' perceptions of their most recent emergency room visit. Semi-structured, in-depth interviews were conducted with 41 men and women from two socially distinct neighbourhoods in Hamilton, Ontario, Canada. Much of the previous work on experiences in emergency room care is international in scope and uses quantitative methods to examine patient satisfaction with emergency care. This study considers patient experiences more broadly and looks beyond satisfaction to examine reasons for seeking emergency room care and the factors that shape experiences. The findings show that most patients describe their experiences in negative terms. The aspects of emergency room care that were most often linked with negative experiences were waiting times, patient perceptions of the quality of care received and staff-patient interactions. The findings are discussed in the context of recent health care reforms in Canada, which we argue have not addressed adequately the 'crisis' in emergency rooms.

Attitude to Health↗

PubMed2005

'Reasonable access' to primary care: assessing the role of individual and system characteristics.

Access to health care continues to be an important issue for health policy makers, researchers, service providers and consumers alike. In countries with universal health care coverage, services are generally free at the point of delivery which is intended to provide equitable access to care for all residents regardless of their individual situations. Past studies have pointed to the importance of individual characteristics such as age, gender, and socioeconomic status in shaping access to health care but much less is known about the role of health system characteristics. The purpose of this study is to explore, by means of qualitative research methods, the extent to which individual and system factors shape access to primary health care services for residents living in two contrasting neighbourhoods in Hamilton, Ont., Canada. Semi-structured, in-depth interviews were conducted with 40 men and women. The interviews probed participants about their experiences with primary care, barriers to receiving care and their general perceptions of the health care system. The interviews demonstrated the existence of many system-related barriers to receiving health care (e.g., wait times, geographic inaccessibility and quality of care) and some individual-related barriers (e.g., work or family responsibilities). While the findings revealed little difference between the neighbourhoods in terms of accessibility problems and barriers, differences between men and women were evident.

Attitude to Health↗

PubMed2005

Meeting health need, accessing health care: the role of neighbourhood.

Much of what we know about the determinants of access to health care comes from studies undertaken at a large scale, such as between cities, regions/counties/provinces/states and countries. This paper examines local level variations in access to and utilization of health care services across four distinct neighbourhoods in Hamilton, Ontario, Canada. Survey data (n = 1500) were analysed using logistic regression to explore the potential relationships between neighbourhood and health care utilization and unmet health care need. Results show some relationships between neighbourhood of residence and levels of reported utilization as well as unmet need, even when controlling for predisposing, enabling, and need factors (i.e. Age, gender, household composition, income, education, perceived gp visit time) as well as health status. Findings from this empirical study suggest a finer lens is required to examine the mechanisms through which place impacts access to and utilization of care, one that recognizes the roles of compositional, contextual and collective aspects of neighbourhood.

Adolescent↗

PubMed2005

Heterogeneities in the production of health: smoking, health status and place.

The harmful effects of smoking on health are well-established. However, little attention has been given to possible variations in the size of the association within populations. In this paper, we test for neighbourhood variation in the smoking-health relationship. We estimate equations to explain variations in self-reported health using data from a survey of adults in four distinct neighbourhood clusters in Hamilton, Ontario. After controlling for neighbourhood composition, the probability of being unhealthy remained significantly higher in the two lower socioeconomic status neighbourhoods (North East and Downtown) than in the rest of the city. The smoking-health association was not the result of more smokers living in less healthy neighbourhoods. In the Downtown neighbourhood, the relative odds of being unhealthy among smokers compared to non-smokers was less than one-half of the corresponding relative odds in the rest of the city. Although smoking represents a health risk for individuals in all neighbourhoods, for individuals living in the Downtown neighbourhood the size of this risk is substantially smaller than for individuals in other neighbourhoods.

Adult↗

PubMed2005

Protective behavior and West Nile virus risk.

We conducted a cross-sectional, household survey in Oakville, Ontario, where an outbreak of West Nile virus (WNV) in 2002 led to an unprecedented number of cases of meningitis and encephalitis. Practicing > or =2 personal protective behavior traits reduced the risk for WNV infection by half.

Adolescent↗

PubMed2004

Who you know, where you live: social capital, neighbourhood and health.

This article examines the degree to which relationships between social capital and health are embedded in local geographical contexts and influenced by demographic factors, socio-economic status, health behaviours and coping skills. Using data from a telephone survey of a random sample of adults (N=1504 respondents, response rate=60%), the article determines if relationships between involvement in voluntary associations and various measures of individual health are associated with neighbourhood of residence in the mid-sized city of Hamilton, Canada. Associational involvement and overweight status (assessed by body-mass score) were weakly but significantly related after controlling for the other variables; involvement had relationships with self-rated health and emotional distress before but not after controlling for socio-economic status, health behaviours and coping skills. Relationships between neighbourhood of residence and two health outcomes, self-rated health and overweight status, were statistically significant before and after controlling for the other characteristics of respondents; neighbourhood of residence was not a significant predictor of number of chronic conditions and emotional distress in multivariate models. The neighbourhood and associational involvement relationships with health were not dependent upon one another, suggesting that neighbourhood of residence did not help to explain the positive health effects of this particular measure of social capital.

Adaptation, Psychological↗

PubMed2004

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.

Canada↗

PubMed2004

Capacity and transparency of potable water regulation in Tijuana, Mexico: challenges for ensuring water quality at community level.

The ability of public institutions to provide efficient and equitable potable water services is key to reducing water-borne diseases, one of the leading causes of morbidity and mortality in the developing world. In this article, a case study of potable water and public health programs in Tijuana, Mexico, is used to direct attention to practical examples of policy and institutional incapacities. A qualitative methodology was used to gain access to local context and the formal and informal actions of the key informants. This paper concludes that public health agencies are creating the illusion of program action through disease surveillance, however capacity gaps demonstrate that institutional policy is not pragmatically reflected on the local community level. Political client-patron relationships are used to circumvent bureaucratic barriers and distribute resources at the local level. This raises the question of whether further accountability will bring the much-expected equitable distribution of public goods in the developing world.

Developing Countries↗

PubMed2003

Drawing the battle lines: tracing the "Science War" in the construction of the chloroform and human health risks debate.

The United States Environmental Protection Agency (US EPA) and the Chlorine Chemistry Council, the Chemical Manufacturers Association, and others have been embroiled in a legal challenge concerning the US EPA's "reversal" regarding the scientific assessment of chloroform's carcinogenicity. This issue arose during the US EPA's November 1998 promulgation of a Maximum Contaminant Level Goal for chloroform in the Stage 1 Final Rules for Disinfectants and Disinfection Byproducts in drinking water. In this paper we adopt a claimsmaking approach: to trace the development and outcome of the chloroform court challenge in the USA, to examine the construction of scientific knowledge claims concerning chloroform risk assessments, and to investigate how different interpretations of scientific uncertainties regarding the evidence are contested when such uncertainties are brought into a regulatory and judicial arena. This "science war" (Chlorine Chemistry Council and others v. US EPA and others) took place in the US Court of Appeals for the District of Columbia Circuit. The scientific "authority" in the construction of scientific claims in this dispute is based on the International Life Sciences Institute expert panel report on chloroform. Examining these science wars is important because they signal critical shifts in science policy agendas. The regulatory outcome of the chloroform science war in the United States can have profound implications for the construction and acceptance of scientific claims regarding drinking water in other jurisdictions (e.g., Canada). In this challenge, we argue that the actors involved in the dispute constructed "boundaries" around accepted and credible scientific claims.

Carcinogens↗

PubMed2003

Does deliberation make a difference? Results from a citizens panel study of health goals priority setting.

How to involve the public in setting health and health care priorities is a constant challenge for health system decisions. Policy maker interest in involving the public in increasingly complex and value-laden priority setting processes has led to the use of deliberative public involvement methods designed to promote discussion and debate among participants with the objective of obtaining more informed and consensual views. These methods have not been evaluated rigorously using controlled designs with pre- and post-test measurements. We examined, using a controlled design, the effects of introducing different opportunities for deliberation into a process for obtaining public input into a community health goals priority setting process. Our findings indicate that deliberation does make a difference to participant views. As more deliberation is introduced, participant views may be more amenable to change. Deliberation also offers the potential for views to become more rather than less entrenched. While we are beginning to understand the difference deliberation makes to participant views, we are still at an early stage in understanding the process through which these differences come about and what difference deliberation makes to broader outcomes such as civic competence, civic engagement and health policy decisions.

Adult↗

PubMed2003

Different frames, different fears: communicating about chlorinated drinking water and cancer in the Canadian media.

Risk issues become complicated when scientific evidence concerning a potential environmental exposure is equivocal; particularly when many argue that the public health benefits of a policy action outweigh any potential negative health effects. Chlorinated drinking water, and chlorinated disinfection byproducts (CDBPs) that are formed during the disinfection process, represent a useful case-study for examining these complications. We conduct a media analysis of chlorinated drinking water stories in the Canadian print media from 1977 to 2000. We examine media presentations of science compared to framings by scientists, regulators, the chlorine industry, water utility representatives, and non-governmental organizations of the CDBP issue based on key informant interviews. We argue that there are two main framings of the debate, each of which are powerful in constructing risk perceptions. On the one hand, many frame the debate as a 'voluntary' risk: we choose chlorine disinfection to protect against microbial risks with a possible adverse consequence of that protection. On the other hand, others frame the issue as an 'involuntary' risk: chlorine disinfection was a 'choice' imposed by public health and water utility officials; a choice that carries a potential cancer risk, and alternative disinfection technologies are advocated. We demonstrate these different frames by examining metaphorical constructs of water, chlorine and cancer contained within them.

Bibliometrics↗

PubMed2003

Deliberations about deliberative methods: issues in the design and evaluation of public participation processes.

A common thread weaving through the current public participation debate is the need for new approaches that emphasize two-way interaction between decision makers and the public as well as deliberation among participants. Increasingly complex decision making processes require a more informed citizenry that has weighed the evidence on the issue, discussed and debated potential decision options and arrived at a mutually agreed upon decision or at least one by which all parties can abide. We explore the recent fascination with deliberative methods for public involvement first by examining their origins within democratic theory, and then by focusing on the experiences with deliberative methods within the health sector. In doing so, we answer the following questions "What are deliberative methods and why have they become so popular? What are their potential contributions to the health sector?" We use this critical review of the literature as the basis for developing general principles that can be used to guide the design and evaluation of public involvement processes for the health-care sector in particular.

Community Participation↗

PubMed2002

'The public is too subjective': public involvement at different levels of health-care decision making.

There are a number of impulses towards public participation in health care decision making including instrumentalist, communitarian, educative and expressive impulses and the desire for increased accountability. There has, however, been little research looking systematically at the public's preferences for being involved in particular types of rationing decisions, nor indeed, has there been a critical examination of the degree of involvement desired by the public. The research reported here uses findings from focus groups and in-depth interviews to explore these questions. Eight focus groups were conducted with a total of 57 informants, four amongst randomly selected members of the public and four with informants from health and non-health related organisations. Nineteen interviews were conducted to allow the elaboration of focus group comments, to probe views more deeply and to pursue emerging themes. The findings show variations in the willingness of members of the public to be involved in health care decisions and consistency across the different forms of the public as represented by the focus groups with randomly selected citizens and pre-existing organisations. There was a strong desire in all the groups for the public to be involved both at the system and programme levels, with much less willingness to be involved at the individual level. At the system and programme levels informants generally favoured consultation, without responsibility for decisions, but with the guarantee that their contribution would be heard and that decisions taken following consultation would be explained. At the patient level informants felt that the public should participate only by setting criteria for deciding between potential beneficiaries of treatment. The public has much to contribute, particularly at the system and programme levels, to supplement the inputs of health care professionals.

Attitude to Health↗

PubMed2002

"If there were a war tomorrow, we'd find the money": contrasting perspectives on the rationing of health care.

In spite of the substantial academic effort being devoted to the subject of health care rationing, there is little clarity about the views of those working in health care who have to implement rationing nor about the views of citizens who are (potentially) affected by the rationing of care. This paper reports the findings of a study conducted using focus groups and semi-structured interviews to explore and compare beliefs about rationing among citizens and those with a role in the health service (service informants) within the context of health care provision in the UK. Citizen and service informants both identified external pressures on the resources available for health care including technological improvement, the ageing population and increasing public expectations. Citizens, however, also identified such factors as the political choice to provide insufficient funds to the health service and the wasteful use of resources that are available. The predominant view was that these latter factors were amenable to change and thus that there are alternatives to the rationing of care. Some citizens accepted that some health care rationing might be necessary. Service informants, on the other hand, were cynical about prospects of increased funding and viewed further reductions in management as untenable. For them, rationing was an inevitability to be managed. A number of these informants felt that rationing should become more explicit, suggesting that openness made rationing both more democratic and more practical. Others, however, believed that explicit rationing would have a number of uncomfortable implications. The paper concludes by suggesting that if rationing is to become more explicit, its inevitability, as perceived by those working within health care, will have to be communicated to citizens.

Attitude of Health Personnel↗