Searching for ‘Best’ Practices in Aboriginal Health Programming

& Service Delivery in Alberta

Marcy Burka-Charles, MScCalgary Health Region

AcknowledgementThis geographic area to be thetraditional territory of the Mi’kmaqpeople from… Mainland Nova Scotia Cape Breton Island

Overview Background Project Activities Evaluation Methodology Key Results

Background Partners:

6 Regional Health Authorities (RHAs)

Steering Committee: RHA representatives Govern project activities

Provincially Funded: Aboriginal Health Strategy

Project Fund

cont. Background Objectives:

Establish a base-line inventory of ‘best’ practices Assess ‘effectiveness’ of RHA funded projects

(1999 – 2005)

Significance: Future funding models Future research agenda

Project Activities2. Literature Review

3. Model Consensus

1. Inventory

n = 82 (1999 - 2005)

community health initiatives

‘Best’ practice…. n = 100 periodicals & non-periodicals

No universal definition

a strategy, activity, approach, or program found to be effective through research, evaluation, &/or experience

Models reviewed were primarily euro-centric & concentric. Most published models omitted culture & spirituality as ‘best’ practice attributes

Better Practice Model Three-phase model

Incorporates Indigenous & Western health ideologies

Synthesizes evidence from both research & practice

FlexibleSource: Cameron et al (2001).

Evaluation Methodology1. Scope of Review

Broad Subjects: Aboriginal Albertans

2. Data Sources Literature Review Document Review Focus Group Interviews (FGIs)

3. Analysis Better Practice Criteria (3 categories) Thematic Analysis

4. Recommendations Practice Research

Model ModificationsData Sources

Literature Review Document Review FGIs

• Effectiveness Criteria: assess selection bias, study design, blinding, confounders, data collection methods, non- responders, etc.

• Limitations:

• Scope of review too broad

• Solution:

• extract examples of better practices from document review

• apply criteria to future literature review

• Plausibility Criteria: assesses program/service potential vs. effectiveness

• Practicality Criteria: assesses affordability, availability, & compatibility

• Attributes applied = 16

• Limitations:

• Report gathering was challenging (18/82)

• no information on need, synergy, sustainability, etc.

• Solution:

• Draft FGI questions

• Plausibility Criteria: questions posed to fulfill information gap from document review (Q 1-4)

• Purposeful Sampling: questions posed (Q 5-6)…

1. What is a ‘best’ or ‘better’ practice?

2. What facilitates it?

3. What hinders it?

• Face Validity Check:

• Stage 1: Respondents

• Stage 2: St. Committee

Key Results – Document ReviewA) Recommended & Promising Practices1. Develop cohesive partnerships2. Hire Aboriginal Health Liaisons & Case Workers3. Incorporate Indigenous language & traditions4. Evaluation

B) ‘To be tracked’ Practices1. Hiring protocols2. Placement of Aboriginal health programs in RHAs

cont. Key Results - FGIsA ‘better’ practice…1. Collaboration2. Education 3. Paradigm shift 4. Research

cont. Key Results - FGIsFacilitators to a ‘better’ practice…1. Formal agreements2. Theoretical approach3. Health system changes4. Champions

cont. Key ResultsBarriers to a ‘better’ practice…1. Inaccurate health statistics2. Institutional culture3. Politics4. Multi-level deficits

cont. Key ResultsMulti-level deficitsincluded… Lack of…

Common vision, mission, goals

Human resources Fiscal resources Time Cultural competence

& safety

Additional Acknowledgements Funding Organization

Alberta Health & Wellness, Alberta Government

Steering Committee & Co-Authors Phillip Burke (Alberta Health & Wellness) Lorraine Deschambeau (Aspen Health Region) Brett Hodson (Calgary Health Region) Malcolm King (ACADRE, University of Alberta) Barb Olsen & Tracy Lee (David Thompson Health Region) Keltie Paul (Northern Lights Health Region) Karoline Phillip (Chinook Health Region) Adrienne Wiebe (Capital Health Region)

Thank You!