Sunday, March 30, 2008

Keys to Women's Health: Phase 2

Keys to Women's Health: Phase 2 is coming to a close with the end of the government fiscal year. Our role was the preparation of two Manuals, one to support dissemination of the findings of the first phase to participants and service providers, and the second to guide the Inclusion Researchers as they made the transition to facilitating Health Circles in each of the three study sites -- Downtown East Toronto, Sudbury, and Peel. This draft includes modifications introduced during the training of the Inclusion Researchers / Health Circle Facilitators in late January, which F&A designed and delivered.

This is very exciting work that we hope will lead to a third phase in which the methodology is rolled out across the province of Ontario. The first phase had women drawn from among the population under study, disadvantaged or marginalized women, in three different communities -- homeless or under-housed women in Downtown East Toronto, Aboriginal and other women served by a Women's Centre in Sudbury, and recent immigrants from South Asia -- trained as Inclusion Researchers. They organized and ran focus groups to collect data about what the women in their marginalized community knew and wanted to know about preventing stroke. The data was analyzed in conjunction with staff from the host agencies and members of the Provincial Advisory Committee (primarily senior health promotion and research experts), under the direction of Dr. Suzanne Jackson of University of Toronto's Centre for Health Promotion. This Phase was published and launched last spring. (see F&A main page for full report)

The findings gave the clear message that women preferred to learn about health in small discussion groups composed and led by women like themselves, and that they needed and wanted help to address life circumstances that limited their ability to make good health choices. Interestingly, the life circumstances they identified, similarly across all three sites, were what the health promotion world calls the Social Determinants of Health.

The second phase of the work, supported by the same partners, explored whether Inclusion Researchers or women like them, women chosen from among the population under study, could be effective as facilitators of discussion groups that helped participants identify and work together to address a group-selected Determinant of Health that got in the way of making good health decisions. The discussion focussed on stroke, but it is very clear that the methodology could equally well be applied to a number of other chronic conditions or illnesses.

The Inclusion Researchers / Facilitators, in conjunction with staff from their host agencies, first organized at least two events at which they shared the findings of the first Phase and introduced the second Phase. They were then trained by F&A to organize and run Health Circles, to become Facilitators instead of Researchers. F&A wrote and circulated a draft Training Manual before meeting in person for training in late January. The group included agency partners and Inclusion Researchers/ Facilitators from all three sites working together over 1 1/2 hard-working days. They made significant changes to the methodology and left confident that they were ready to set up and facilitate at least two groups in each site. They have subsequently done so, and the energy that has been unleashed is breath-taking. Each site has found its own particular application for the methodology going forward, but all have found it very powerful in engaging and working effectively with marginalized women in their service population. The full report, with independent evaluation, will be published soon -- watch for it here.

The marginalized pose a very serious problem for the health system. They are at increased risk to suffer from chronic illness but are notoriously hard to engage in traditional prevention, early intervention or effective treatment. The health system will continue to waste money and effort unless they find a more effective way of engaging with this population. We think this may be a leading edge approach to doing so.

Furthermore, because the Facilitators themselves are drawn from among the population, the approach quickly builds community capacity and competence. We are just beginning to see the side benefits over time from creating an employment trajectory, a career path, for the Inclusion Researchers / Facilitators. It is becoming evident in their individual lives (as their lives stabilize, they return to education, they get 'regular' employment), in the agencies that shired them (programming is energized, credibility is enhanced, collegial cooperation is strengthened), and in the communities from which they are drawn (a new sense of hope and empowerment). This is Community Based Research at its most potent.

We are very pleased to have been part of this work. We hope the methodology will find broad application.

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