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Childhood is a critical stage to develop healthy behaviours, and the school years are an important developmental period in which children are learning and growing. School-based health promotion interventions are increasingly using the comprehensive school health (CSH) approach that has been found effective at improving health behaviours, while adapting to the school and community context to create and sustain a healthy school culture. The interconnected environments of school, home and community are key to the CSH approach, however, there is minimal research that has been conducted to determine the impact at the community-level. This research used a qualitative multiple case study design to explore the influence of a school-based health promotion intervention, APPLE Schools, on the school and community environments from the perspectives of school staff in Alberta, Canada. Twenty-two participants participated in walking interviews in five schools. The walking interview approach combined interviewing and field observation and empowered participants to share their local expertise and knowledge within the context of school and community environments. Interviews were transcribed and analysed using an inductive thematic approach. Four themes were identified: APPLE schools look different, APPLE Schools build champions, APPLE Schools builds community partnerships and APPLE Schools honours community culture. Health promotion practice in schools was uniquely adapted based on strengths and needs of each school and was broadly influenced by the community outside of school walls. In sum, it was found that school-based health promotion reaches beyond school walls and can influence the broader community environment., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Children are exposed to food environments that make nutrient-poor, energy-dense food cheap, readily available and heavily marketed; all conditions with potential negative impacts on diet and health. While the need for programmes and policies that improve the status of food environments is clear, greater public support is needed for governments to act. The purpose of this qualitative collective case study was to examine if community engagement in the Local Environment Action on Food (LEAF) project, a community-based food environment intervention in Alberta, Canada, could build public support and create action to promote healthy food environments. Semi-structured interviews with a purposeful sample of 26 stakeholders from 7 communities explored LEAF's impact and stakeholder experiences creating change. Data collection and analysis were iterative, following Charmaz's constant comparative analysis strategy. Participants reported environmental and community impacts from LEAF. Notably, LEAF created a context-specific tool, a Mini Nutrition Report Card, that communities used to promote and support food environment action. Further, analysis outlined perceived barriers and facilitators to creating community-level food environment action, including level of engagement in LEAF, perceived controllability, community priorities, policy enforcement and resources. Findings from this study suggest that community-based interventions, such as LEAF, can help build community capacity and reduce existing barriers to community-level food environment action. Thus, they can provide an effective method to build public awareness, demand and action for healthier food environments., (© The Author(s) 2021. Published by Oxford University Press.)

Background: Recreation and sport facilities often have unhealthy food environments that may promote unhealthy dietary patterns among children. In response, some Canadian provinces have released voluntary nutrition guidelines for recreation and sport facilities, however implementation has been limited. Organizational capacity building may overcome barriers to implementing guidelines. Eat, Play, Live was a randomized controlled trial embedded within a natural experiment that tested the impact of an 18 month capacity building intervention (CBI) in enhancing implementation of provincial nutrition guidelines, and whether nutrition guidelines were associated with positive changes. Primary outcomes were facility capacity, policy development and food environment quality., Methods: Recreation and sport facilities in three guideline provinces were randomized into a guideline + CBI (GL + CBI; n = 17) or a guideline only comparison condition (GL-ONLY; n = 15). Facilities in a province without guidelines constituted a second comparison condition (NO-GL; n = 17). Facility capacity, policy development, and food environment quality (vending and concession) were measured and compared at baseline and follow-up across conditions using repeated measures ANOVA and Chi-square statistics. Healthfulness of vending and concession items was rated as Do Not Sell (least nutritious), Sell Sometimes or Sell Most (most nutritious)., Results: There were significant time by condition effects, with significant increases in facility capacity (mean ± SD: 30.8 ± 15.6% to 62.3 ± 22.0%; p <  0.01), nutrition policy development (17.6% developed new policies; p = 0.049), overall quality of the concession food environment (14.7 ± 8.4 to 17.5 ± 7.2; p <  0.001), and in the proportion of Sell Most (3.7 ± 4.4% to 11.0 ± 9.0%; p = 0.002) and Sell Sometimes vending snacks (22.4 ± 14.4% to 43.8 ± 15.8%; p <  0.001) in GL + CBI facilities, with a significant decline in Do Not Sell vending snacks (74.0 ± 16.6% to 45.2 ± 20.1%; p <  0.001)., Conclusions: Significant improvements in facility capacity, policy development and food environment quality occurred in recreation and sport facilities that were exposed to nutrition guidelines and participated in a CBI. Outcomes did not improve in facilities that were only passively or not at all exposed to guidelines. Ongoing capacity building may enhance implementation of voluntary nutrition guidelines, however food environments remained overwhelmingly unhealthy, suggesting additional scope to enhance implementation., Trials Registration: Clinical trials registration (retrospectively registered): ISRCTN14669997 Jul 3, 2018.

Objective: To assess and compare the favourability of healthy public policy options to promote healthy eating from the perspective of members of the general public and policy influencers in two Canadian provinces., Design: The Chronic Disease Prevention Survey, administered in 2016, required participants to rank their level of support for different evidence-based policy options to promote healthy eating at the population level. Pearson's χ 2 significance testing was used to compare support between groups for each policy option and results were interpreted using the Nuffield Council on Bioethics' intervention ladder framework., Setting: Alberta and Québec, Canada.ParticipantsMembers of the general public (n 2400) and policy influencers (n 302) in Alberta and Québec., Results: General public and policy influencer survey respondents were more supportive of healthy eating policies if they were less intrusive on individual autonomy. However, in comparing levels of support between groups, we found policy influencers indicated significantly stronger support overall for healthy eating policy options. We also found that policy influencers in Québec tended to show more support for more restrictive policy options than their counterparts from Alberta., Conclusions: These results suggest that additional knowledge brokering may be required to increase support for more intrusive yet impactful evidence-based policy interventions; and that the overall lower levels of support among members of the public may impede policy influencers from taking action on policies to promote healthy eating.

Competing Interests: Competing interests: Norman Campbell reports receiving personal fees from the Novartis Foundation (2016–2017) to support the Better Hearts Better Cities program, which included travel support for site visits and a contract to develop a survey. He also reports receiving personal fees for providing consultative advice on accurate blood pressure assessment to Midway Corporation (2017). He is an unpaid member of World Action on Salt and Health. No other competing interests were declared.

Introduction: The lack of policy, practice and research action on physical activity and features of the physical (built and natural) environments in rural, remote and northern settings is a significant threat to population health equity in Canada. This paper presents a synthesis of current evidence on the promotion of physical activity in non-urban settings, outcomes from a national priority-setting meeting, and a preliminary call to action to support the implementation and success of population-level initiatives targeting physical activity in non-urban settings., Methods: We conducted a "synopses of syntheses" scoping review to explore current evidence on physical activity promotion in rural, remote, northern and natural settings. Next, we facilitated a collaborative priority-setting conference with 28 Canadian experts from policy, research and practice arenas to develop a set of priorities on physical activity in rural, remote and northern communities. These priorities informed the development of a preliminary Canadian call to action., Results: We identified a limited number of reviews that focused on physical activity and the built environment in rural, remote and northern communities. At the prioritysetting conference, participants representing rural, remote and northern settings identified top priorities for policy, practice and research action to begin to address the gaps and issues noted in the literature. These priorities include self-identifying priorities at the community level; compiling experiences; establishing consistency in research definitions and methods; and developing mentorship opportunities., Conclusion: Coordinated action across policy, practice and research domains will be essential to the success of the recommendations presented in this call to action., Competing Interests: The authors declare that they have no conflicts of interest.

To achieve food security in Canada, comprehensive approaches are required, which involve action at the public policy level. This qualitative study explored the experiences of 14 stakeholders engaging in a 9-month participatory public policy advocacy project to promote community food security in the province of Alberta through the initiation of a campaign to develop a Universal School Food Strategy. Through this exploration, four main themes were identified; a positive and open space to contribute ideas, diversity and common ground, confidence and capacity, and uncertainty. Findings from this study suggest that the participatory advocacy project provided a positive and open space for stakeholders to contribute ideas, through which the group was able to narrow its focus and establish a goal for advocacy. The project also seems to have contributed to the group's confidence and capacity to engage in advocacy by creating a space for learning and knowledge sharing, though stakeholders expressed uncertainty regarding some aspects of the project. Findings from this study support the use of participatory approaches as a strategy for facilitating engagement in public policy advocacy and provide insight into one group's advocacy experience, which may help to inform community-based researchers and advocates in the development of advocacy initiatives to promote community food security elsewhere., (© 2016 Society for Public Health Education.)

Many recreation and sports facilities have unhealthy food environments, however managers are reluctant to offer healthier foods because they perceive patrons will not purchase them. Preliminary evidence indicates that traffic light labeling (TLL) can increase purchase of healthy foods in away-from-home food retail settings. We examined the effectiveness of TLL of menus in promoting healthier food purchases by patrons of a recreation and sport facility concession, and among various sub-groups. TLL of all menu items was implemented for a 1-week period and sales were assessed for 1-week pre- and 1-week post-implementation of TLL (n = 2101 transactions). A subset of consumers completed a survey during the baseline (n = 322) and intervention (n = 313) periods. We assessed change in the proportion of patrons' purchases that were labeled with green, yellow and red lights from baseline to the TLL intervention, and association with demographic characteristics and other survey responses. Change in overall revenues was also assessed. There was an overall increase in sales of green (52.2% to 55.5%; p < 0.05) and a reduction in sales of red (30.4% to 27.2%; p < 0.05) light items from baseline to the TLL period. The effectiveness of TLL did not differ according to any of the demographic or other factors examined in the survey. Average daily revenues did not differ between the baseline and TLL periods. TLL of menus increased purchase of healthy, and reduced purchase of unhealthy foods in a publicly funded recreation and sport facility, with no loss of revenue. Policymakers should consider extending menu labeling laws to public buildings such as recreation and sports facilities to promote selection of healthier items., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Purpose: The knowledge, attitudes, and beliefs of key policy influencers and the general public can support or hinder the development of public policies that support cancer prevention. To address gaps in knowledge concerning healthy public policy development, views on cancer causation and endorsement of policy alternatives for cancer prevention among government influencers (elected members of legislative assemblies and senior ministry bureaucrats), non-governmental influencers (school board chairs and superintendents, print media editors and reporters, and workplace presidents and senior human resource managers), and the general public were compared., Methods: Two structured surveys, one administered to a convenience sample of policy influencers (government and non-governmental) and the other to a randomly selected sample of the general public, were used. The aim of these surveys was to understand knowledge, attitudes, and beliefs regarding health promotion principles and the priority and acceptability of policy actions to prevent four behavioral risk factors for cancer (tobacco use, alcohol misuse, unhealthy eating, and physical inactivity). Surveys were administered in Alberta and Manitoba, two comparable Canadian provinces., Results: Although all groups demonstrated higher levels of support for individualistic policies (e.g., health education campaigns) than for fiscal and legislative measures, the general public expressed consistently greater support than policy influencers for using evidence-based policies (e.g., tax incentives or subsidies for healthy behaviors)., Conclusions: These results suggest that Canadian policy influencers may be less open that the general public to adopt healthy public policies for cancer prevention, with potential detriment to cancer rates.

Objective: As overweight and obesity is a risk factor for chronic diseases, the development of environmental and healthy public policy interventions across multiple sectors has been identified as a key strategy to address this issue., Methods: In 2009, a survey was developed to assess the attitudes and beliefs regarding health promotion principles, and the priority and acceptability of policy actions to prevent obesity and chronic diseases, among key policy influencers in Alberta and Manitoba, Canada. Surveys were mailed to 1,765 key influencers from five settings: provincial government, municipal government, school boards, print media companies, and workplaces with greater than 500 employees. A total of 236 surveys were completed with a response rate of 15.0%., Results: Findings indicate nearly unanimous influencer support for individual-focused policy approaches and high support for some environmental policies. Restrictive environmental and economic policies received weakest support. Obesity was comparable to smoking with respect to perceptions as a societal responsibility versus a personal responsibility, boding well for the potential of environmental policy interventions for obesity prevention., Conclusions: This level of influencer support provides a platform for more evidence to be brokered to policy influencers about the effectiveness of environmental policy approaches to obesity prevention., (© 2014 The Obesity Society.)

Community capacity-building is a central element to health promotion. While capacity-building features, domains and relationships to program sustainability have been well examined, information on the process of capacity-building as experienced by practitioners is needed. This study examined this process as experienced by coordinators working within a community-based chronic disease prevention project implemented in four communities in Alberta (Canada) from 2005-2010 using a case study approach with a mixed-method design. Data collection involved semi-structured interviews, a focus group and program documents tracking coordinator activity. Qualitative analysis followed the constant comparative method using open, axial and selective coding. Quantitative data were analyzed for frequency of major activity distribution. Capacity-building process involves distinct stages of networking, information exchange, partnering, prioritizing, planning/implementing and supporting/ sustaining. Stages are incremental though not always linear. Contextual factors exert a great influence on the process. Implications for research, practice and policy are discussed., (© The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Improving the nutritional health of the public continues to be a major challenge. Our mission of advancing health through food and nutrition has become increasingly complex, particularly as food environments shape the availability, affordability, and social acceptability of food and nutrition "choices". Promoting nutritional health requires that dietitians expand our knowledge in understanding the determinants of healthy eating and of social change strategies that advocates for and acts on improving food environments. While no single strategy can solve the challenges of public health nutrition, we can each identify unique strengths and opportunities. If we practice in complementary ways, using those strengths for collective action will make us stronger together toward social change supporting improved nutritional health of the public.

Objective: To assess the impact of a 3 year (2006-2009) community-based intervention for obesity and chronic disease prevention in four diverse "Healthy Alberta Communities" (HAC)., Methods: Targeted intervention development incorporated the ANGELO conceptual framework to help community stakeholders identify environmental determinants of obesity amenable to intervention. Several inter-related initiatives were implemented. To evaluate, we surveyed separate samples of adults in HAC communities before and after the interventions and compared responses to identical survey questions asked of adults living in Alberta in two waves of the Canadian Community Health Survey (CCHS)., Results: The HAC sample included 4761 (2006) and 4733 (2009) people. The comparison sample included 9775 and 9784 respondents in 2005 and 2009-10 respectively. Self-reported body mass index showed no change, and neither were there significant changes in behaviors relative to secular trends. Most significant outcomes were relevant to social conditions, specifically sense of belonging to community in the intervention communities., Conclusion: Health outcome indicators at the community level may not be sufficiently sensitive to capture changes which, over a relatively short term, would only be expected to be incremental, given that interventions were directed primarily to creating environmental conditions supportive of changes in behavioral outcomes rather than toward health outcome change directly., (© 2013. Published by Elsevier Inc. All rights reserved.)

Objective: Unhealthy dietary and physical inactivity patterns inspired many initiatives promoting healthy youth and healthy schools in Alberta between 2005 and 2008. The purpose of this study was to examine differences in the prevalence of lifestyle risk factors for type 2 diabetes (T2D) between two province-wide samples of Alberta adolescents (2005 and 2008)., Methods: The dietary and physical activity (PA) patterns of Alberta youth were assessed in two cross-sectional studies of grade 7-10 students, one in 2005 (n=4936) and one in 2008 (n=5091), using a validated web-survey. For each diabetes risk factor, participants were classified as either at risk or not at risk, depending on their survey results relative to cut-off values. Chi-square tests and logistic regression models were used to determine differences in risk factor prevalence between 2005 and 2008., Results: Compared to 2005, mean BMI, energy intake, fat intake, glycemic index (GI) and glycemic load (GL) were lower in 2008 (p<0.05); and carbohydrate, protein, fibre and vegetable and fruit intakes were higher in 2008 (p<0.05). In 2008, a lower proportion of students were: overweight, obese, consuming high GI, high GL, high fat, low fibre, low veg/fruit intake (p<0.05). No differences existed in magnesium or PA levels between the two time points., Conclusions: Improvements were observed between 2005 and 2008 in terms of the proportion of adolescents having specific risk factors for T2D. The cause of these changes could not be determined. Continued monitoring of adolescent lifestyle habits and monitoring of exposure to health promotion programming is recommended.

We used our experience assisting in the development of and evaluating the Alberta Nutrition Guidelines for Children and Youth (ANGCY) as a basis for exploring roles that registered dietitians (RDs) can play within health promotion, and how others perceive the RD role. Data were generated via 12 key informant interviews and observations during a multiple case study of recreation facilities that had and had not adopted the ANGCY. We also drew on dialogue and personal observations during development of the ANGCY. Dietitians working in government, academia, community settings, private practice, and industry played an important role throughout the development and implementation of the ANGCY. Some sectors proactively sought RD expertise, while others with less ability to pay accessed RDs' services less. Informants generally regarded RDs in a positive light. Findings indicate the profession should incrementally adjust training models to reflect emerging areas of practice, and highlight the need for RDs to proactively seek new avenues in which to apply their skills. These actions will help RDs remain the trusted source of food and nutrition information, not only in health care, but also within health promotion settings.

The Community Health and the Built Environment (CHBE) project investigated the role of place in interventions for chronic disease prevention in order to identify contextual factors that may foster or inhibit intervention success. This paper presents a project model comprising objective-outsider and subjective-insider perspectives in a multi-method, community-based participatory research approach with an emphasis on knowledge exchange. The collaborative process generated valuable lessons concerning effective conduct of community-based research. The CHBE project model contributes a mechanism for investigating how place influences health behaviours and the outcomes of health promotion interventions.

Government actors have an important role to play in creating healthy public policies and supportive environments to facilitate access to safe, affordable, nutritious food. The purpose of this research was to examine Waterloo Region (Ontario, Canada) as a case study for "what works" with respect to facilitating access to healthy, local food through regional food system policy making. Policy and planning approaches were explored through multi-sectoral perspectives of: (a) the development and adoption of food policies as part of the comprehensive planning process; (b) barriers to food system planning; and (c) the role and motivation of the Region's public health and planning departments in food system policy making. Forty-seven in-depth interviews with decision makers, experts in public health and planning, and local food system stakeholders provided rich insight into strategic government actions, as well as the local and historical context within which food system policies were developed. Grounded theory methods were used to identify key overarching themes including: "strategic positioning", "partnerships" and "knowledge transfer" and related sub-themes ("aligned agendas", "issue framing", "visioning" and "legitimacy"). A conceptual framework to illustrate the process and features of food system policy making is presented and can be used as a starting point to  engage multi-sectoral stakeholders in plans and actions to facilitate access to healthy food.

Objectives: Detailed assessments of the built environment often resist data reduction and summarization. This project sought to develop a method of reducing built environment data to an extent that they can be effectively communicated to researchers and community stakeholders. We aim to help in an understanding of how these data can be used to create neighbourhood groupings based on built environment characteristics and how the process of discussing these neighbourhoods with community stakeholders can result in the development of community-informed health promotion interventions., Methods: We used the Irvine Minnesota Inventory (IMI) to assess 296 segments of a semi-rural community in Alberta. Expert raters "created" neighbourhoods by examining the data. Then, a consensus grouping was developed using cluster analysis, and the number of IMI variables to characterize the neighbourhoods was reduced by multiple discriminant function analysis., Results: The 296 segments were reduced to a consensus set of 10 neighbourhoods, which could be separated from each other by 9 functions constructed from 24 IMI variables. Biplots of these functions were an effective means of summarizing and presenting the results of the community assessment, and stimulated community action., Conclusions: It is possible to use principled quantitative methods to reduce large amounts of information about the built environment into meaningful summaries. These summaries, or built environment neighbourhoods, were useful in catalyzing action with community stakeholders and led to the development of health-promoting built environment interventions.

Since the 1980s, ecological models of health promotion have generated a great deal of enthusiasm among researchers and interventionists. These models emerged from conceptual developments in other fields, and only selected elements of the ecological approach have been integrated into them. In this article, we describe the tenets of the ecological approach and highlight those aspects that have been integrated into ecological models used in health promotion. We also analyze how ecological models have been applied to the study of two important public health issues, namely physical activity promotion and the increased consumption of fruits and vegetables, by conducting an archival study of published research. Finally, we make a statement regarding the usefulness of ecological models for research and practice and propose recommendations for future research, program planning, and evaluation.

Current dietary recommendations for cardiovascular disease prevention suggest dietary patterns that promote achieving healthy weight, emphasize vegetables, legumes, fruit, whole grains, fish and nuts, substituting mono-unsaturated fats for saturated fats and restricting dietary sodium to less than 2300 mg/day. However, trends in nutrient intake and food consumption patterns suggest that the need for improvement in the dietary patterns of Canadians is clear. Influencing eating behaviour requires more than addressing nutrition knowledge and perceptions of healthy eating - it requires tackling the context within which individuals make choices. A comprehensive approach to improving nutrition includes traditional downstream strategies such as counselling to improve knowledge and skills; midstream strategies such as using the media to change social norms; and upstream strategies such as creating supportive environments through public policy including regulatory measures. While the evidence base for more upstream strategies continues to grow, key examples of comprehensive approaches to population change provide a call to action.

This article explores facilitators and barriers to individual and organizational capacity to address priority strategies for community-level chronic disease prevention. Interviews were conducted with a group of participants who previously participated in a community priority-setting workshop held in two Alberta communities. The goal of the workshop was to bring together key community stakeholders to collaboratively identify action strategies for preventing chronic diseases in their communities. While capacity building was not the specific aim of the workshop, it could be considered an unintended byproduct of bringing together community representatives around a specific issue. One purpose of this study was to examine the participants' capacity to take action on the priority strategies identified at the workshop. Eleven one-on-one semi-structured interviews were conducted with workshop participants to examine facilitators and barriers to individual and organizational level capacity building. Findings suggest that there were several barriers identified by participants that limited their capacity to take action on the workshop strategies, specifically: (i) organizations' lack of priorities or competing priorities; (ii) priorities secondary to the organizational mandate; (iii) disconnect between organizational and community priorities; (iv) disconnect between community organization priorities; (v) disconnect between organizations and government/funder priorities; (vi) limited resources (i.e. time, money and personnel); and, (vii) bigger community issues. The primary facilitator of individual capacity to take action or priority strategies was supportive organizations. Recognition of these elements will allow practitioners, organizations, governments/funders, and communities to focus on seeking ways to improve capacity for chronic disease prevention.

This paper provides a baseline profile of organizational capacity for (heart) health promotion in Alberta's regional health authorities (RHAs); and examines differences in perceived organizational health promotion capacity specific to modifiable risk factors across three levels of staff and across capacity levels. Baseline data were collected from a purposive sample of 144 board members, senior/middle managers and service providers from 17 RHAs participating in a five-year time-series repeated survey design assessing RHA capacity for (heart) health promotion. Results indicate low levels of capacity to take health promotion action on the broader determinants of health and risk conditions like poverty and social support. In contrast, capacity for health promotion action specific to physiological and behavioural risk factors is considerably higher. Organizational "will" to do health promotion is noticeably more present than is both infrastructure and leadership. Both position held within an organization as well as overall level of organizational capacity appear to influence perceptions of organizational capacity. Overall, results suggest that organizational "will", while necessary, is inadequate on its own for health promotion implementation to occur, especially in regard to addressing the broader determinants of health. A combination of low infrastructure and limited leadership may help explain a lack of health promotion action.

Background: Canadian political discourse supports the importance of health promotion and advocates the allocation of health resources to health promotion. Furthermore, the current literature frequently identifies financial and human resources as important elements of organizational capacity for health promotion. In the Alberta Heart Health Project (AHHP), we sought to learn if the allocation of health resources in a regionalized health system was congruent with the espoused support for health promotion in Alberta, Canada., Methods: The AHHP used a mixed method approach in a time series design. Participants were drawn from multiple organizational levels (i.e., service providers, managers, board members) across all Regional Health Authorities (RHAs). Data were triangulated through multiple collection methods, primarily an organizational capacity survey, analysis of organizational documents, focus groups, and personal interviews. Analysis techniques were drawn from quantitative (i.e., frequency distributions, ANOVAs) and qualitative (i.e., content and thematic analysis) approaches., Results: In most cases, small amounts (<5%) of financial resources were allocated to health promotion in RHAs' core budgets. Respondents reported seeking multiple sources of public health financing to support their health promotion initiatives. Human resources for health promotion were characterized by fragmented responsibilities and short-term work. Furthermore, valuable human resources were consumed in ongoing searches for funding that typically covered short time periods., Conclusions: Resource allocations to health promotion in Alberta RHAs are inconsistent with the current emphasis on health promotion as an organizational priority. Inadequate and unstable funding erodes the RHAs' capacity for health promotion. Sustainable health promotion calls for the assured allocation of adequate, sustainable financial resources.

Purpose: The purpose of this paper is to examine organizational leadership and its relationship to regional health authority actions to promote health., Design/methodology/approach: Through use of four previously developed measures of Perceived Organizational Leadership for Health Promotion, this paper focused on leadership as a distributed entity within regional health authority (RHA) jurisdictions mandated to address the health of the population in the province of Alberta, Canada., Findings: First, examination of differentials between organizational levels (i.e. board members, n = 30; middle/senior management, n = 58; and service providers, n = 56) on ratings of the four leadership measures revealed significant differences. That is, board members tended to rate leadership components significantly higher than service providers and middle/senior managers: from across all 17 RHAs; and in low health promotion capacity and high health promotion capacity RHAs. Second, regression analyses identified that the leadership measures "Practices for Organizational Learning" and "Wellness Planning" were positively associated with health authority actions on improving population heart health (heart health promotion). The presence of a "Champion for Heart Health Promotion" and the leadership measures "Workplace Milieu" and "Organization Member Development" were also positively associated with health authority actions for health promotion. A subsidiary aim revealed low to moderate positive relationships of the dimensions of Leadership, Infrastructure and Will to Act with one another, as proposed by the Alberta Model on "Organizational Capacity Building for Health Promotion.", Originality/value: This paper, conducted on the baseline dataset (n = 144) of the "Alberta Heart Health Project's Dissemination Phase", represents a rare effort to examine leadership at a collective organizational level.

Purpose: The purpose of this research is to examine the organizational stages of change construct of the transtheoretical model of behavior change., Design/methodology/approach: Data on organizational and individual stages of change for tobacco reduction, physical activity promotion, and heart healthy eating promotion were collected from service provider, senior management, and board level members of provincial health authorities across three data collection periods., Findings: Results revealed significant correlations between individual and organizational stages of change for management level respondents, but inconsistent relationships for service providers and no significant correlations for board level respondents. There were no significant differences between respondent levels for organizational stage of change for any of the promotion behaviors. In general, changes in stage failed to predict whether there was a belief in an organization's capability of addressing any of the health promotion activities. There was also a large amount of variance between individual respondents for most health authorities in their reported organizational stages of change for physical activity and healthy eating., Practical Implications: Based on the results of the present study it is concluded that there is little evidence that the organizational stages of change construct is valid. The evidence indicates that assessing individual readiness within an organization may be as effective as asking individuals to report on organizational stages of readiness., Originality/value: This paper reports on the validity of the organizational stages of change construct in a health promotion context and provides information for those who are considering using it.

This article uses a population health perspective to examine the complex set of interactions among the determinants of healthy eating. An overview of current knowledge on determinants of healthy eating was organized as follows: 1) individual determinants of personal food choices and 2) collective determinants, including a) environmental determinants as the context for eating behaviours and b) public policies as creating supportive environments for healthy eating. A conceptual synthesis of the literature revealed that individual determinants of personal food choice (physiological state, food preferences, nutritional knowledge, perceptions of healthy eating and psychological factors) are necessary, but not sufficient, to explain eating behaviour, which is highly contextual. Collective determinants of eating behaviour include a wide range of contextual factors, such as the interpersonal environment created by family and peers, the physical environment, which determines food availability and accessibility, the economic environment, in which food is a commodity to be marketed for profit, and the social environment, in which social status (income, education and gender) and cultural milieu are determinants of healthy eating that may be working "invisibly" to structure food choice. Policy is a powerful means of mediating multiple environments. There are gaps in our understanding of the process of intervening in macro-level environments and the impact of such interventions on the promotion of healthy eating. Collective determinants of food choice and policy contexts for promoting healthy eating, therefore, require investment in research. Applying a population health promotion lens to understanding the multiple contexts influencing healthy eating provides insight into prioritizing research and action strategies for the promotion of healthy eating.

This study describes the development and psychometric evaluation of four scales measuring leadership for health promotion at an organizational level in the baseline survey (n=144) of the Alberta Heart Health Project. Content validity was established through a series of focus groups and expert opinion appraisals, pilot testing of a draft based on capacity assessment instruments developed by other provinces involved in the Canadian Heart Health Initiative, and the literature. Psychometric analyses provided empirical evidence of the construct validity and reliability of the organizational leadership scales. Principal component analysis verified the unidimensionality of the leadership scales of (a) Practices for Organizational Learning, (b) Wellness Planning, (c) Workplace Climate, and (d) Organization Member Development. Scale alpha coefficients ranged between .79 and .91 thus establishing good to high scale internal consistencies. These measures can be used by both researchers and practitioners for the assessment of organizational leadership for health promotion and heart health promotion.

Purpose: The objective of this study was to derive a conceptual model of community capacity development for health promotion based on the 5-year demonstration phase of the Alberta Heart Health Project., Method: Community actions associated with successful implementation and uptake of initiatives in four diverse target sites were identified by case study evaluation., Results: Thirteen common elements of capacity development were found across the projects and categorized to define three primary dimensions of the process: (a) leadership that provided a driving force for implementation, (b) policy making that ensured diffusion and sustainability, and (c) use of local community resources and infrastructure. A conceptual model was constructed using these 3 dimensions and their interactions., Conclusion: Effective implementation of community health initiatives to promote heart health can be conceptualized as the involvement of local leadership, policy advocacy, and enhancement of existing infrastructure. The model highlights building these dimensions of community capacity development for health promotion.

Purpose: This purpose of this research was to develop and establish psychometric properties of scales measuring individual leadership for health promotion., Design/methodology/approach: Scales to measure leadership in health promotion were drafted based on capacity assessment instruments developed by other provinces involved in the Canadian Heart Health Initiative (CHHI), and on the literature. Content validity was established through a series of focus groups and expert opinion appraisals and pilot testing. Psychometric analyses provided empirical evidence of the construct validity and reliability of the leadership scales in the baseline survey (n = 144) of the Alberta Heart Health Project., Findings: Principal component analysis verified the construct of the leadership scales of personal work-related practices and satisfaction with work-related practices. Each of the theoretically a prior determined scales factored into two scales each for a total of four final scales. Scale alpha coefficients (Cronbach's alpha) ranged between 0.71 and 0.78, thus establishing good scale internal consistencies., Research Limitations/implications: Limitations include the relatively small sample size used in determining psychometric properties. In addition, further qualitative work would enhance understanding of the complexity of leadership in health organizations. These measures can be used by both researchers and practitioners for the assessment leadership for health promotion and to tailor interventions to increase leadership for health promotion in health organizations., Originality/value: Establishing the psychometric properties and quality of leadership measures is an innovative step toward achieving capacity assessment instruments which facilitate evaluation of key relationships in developing health sector capacity for health promotion.

This paper describes the development and psychometric evaluation of scales measuring the dimensions of 'will' (belief, confidence, prior action and desire) for heart health promotion specifically and health promotion in general at both an individual and organizational level. Content validity was established through a series of focus groups and expert opinion assessments, based on a compilation of capacity-assessment instruments developed by other provinces involved in the Canadian Heart Health Initiative and the literature. Psychometric analyses of questionnaire data provided empirical evidence of the construct validity and reliability of the 16 individual and 21 organizational level 'will' scales. A series of principal component analyses assisted in verifying the unidimensionality of the measures and all scales yielded high internal consistencies with Cronbach's alpha coefficients ranging between 0.73 and 0.96. These measures can be used by both researchers and practitioners for assessing the 'will' to promote heart health specifically and health promotion in general.

When people involved in children's feeding programs were asked to describe them, without exception they were described using phrases that reflected the perception of 'wonderfulness'. This paper critically analyses the 'wonderfulness' of children's feeding programs by examining the language used to describe these programs, and the features of a 'wonderful' program through an analysis of a multi-site, qualitative case study of nine diverse programs in Atlantic Canada. When participants justified their comments about the 'wonderfulness' of children's feeding programs, they did so based upon five perceptions of program strengths: enhanced family coping; providing good food and nutrition; socializing and making friends; behaving well in school; and volunteerism. We suggest that programs can be designed to be innately 'wonderful' if they are community- and charity-based, support a noble cause such as the elimination of child hunger, engage good people as donors and volunteers, and provide a direct service to children apart from their families. We challenge health promoters to beware of the 'wonderful' program; its 'wonderfulness' may actually be masking unintended negative impacts upon its participants.

Cardiovascular diseases are now the world's leading cause of death. To reduce high rates of such preventable premature deaths, evidence-based approaches to heart health promotion must be disseminated across public health systems. To succeed, we must build capacity to disseminate strategies that are practical and effective. However, we know little about such dissemination, and we lack both conceptual frameworks to guide our thinking and appropriate scientific methodologies. This article presents conceptual and analytic frameworks that integrate several approaches to understanding and studying dissemination processes within public health systems. This work is based on the Canadian Heart Health Dissemination Project, a research program examining a national heart health dissemination initiative. The primary focus is the development of a systematic protocol for measuring levels of capacity and dissemination, and determining successful conditions for, and barriers to, capacity and dissemination, as well as the nature of the relationship between these key concepts.

Background: Comprehensive School Health (CSH) approaches to developing a healthy school community can be effective in supporting chronic disease prevention while positively impacting on student behaviour and academic performance. Although a CSH framework provides principles for action, there is a lack of evidence regarding the processes that best facilitate CSH work, and enable action. Objective: The purpose of this study was to identify and describe the elements of practice-based evidence that contribute to the success and sustainability of healthy school communities, through the identification of positive practices and lessons learned from a sample of projects in Alberta, Canada. Setting: School communities in Alberta, Canada. Design and methods: Key individuals from a list of operating CSH projects were invited for interview. An exploratory, qualitative design examined the perspectives of these "school health champions". A total of 12 one-on-one interviews and one focus group with seven participants were completed, resulting in input from 19 individuals in total. Results: Elements to develop and sustain a healthy school community fall into one of two categories: (1) stakeholder buy-in and (2) adequate resources in the form of human resources, partnerships and peer support. Participants identified successful strategies for establishing buy-in from administrators, teachers, parents and students. Conclusion: To effectively mobilise a comprehensive school health framework, practical strategies for implementation are needed. While some of these strategies are context-specific, practice-based evidence that transcends the local context does exist and can be used more widely to support the development of a healthy school community.

Native American Indians and First Nations are predisposed to obesity and diabetes. A study was done to understand Cree schoolchildren's diabetes awareness and body size perceptions in two communities that had diabetes awareness-raising activities in the Province of Quebec, Canada. Children (N = 203) in grades 4-6 were classified into weight categories using measured heights and weights and grouped on diabetes awareness based on dichotomous responses to the question "Do you know what diabetes is?" Children selected a drawing of an American Indian child whom they felt most likely to get diabetes and described their body size perception using a closed response question. Although 64.5% of children were overweight or obese, most (60.1%) children considered their body size to be "just right", with 29.6% considering it "too big" and 10.3% considering it "too small". A minority (27.6%) of children had diabetes awareness. These children were more likely than children without diabetes awareness to consider their body size too big (42.9 versus 24.5%) and to choose an obese drawing as at risk for diabetes (85.7 versus 63.3%, odds ratio 3.48 and 95% confidence interval 1.53-7.91). Culturally appropriate health education programs to increase schoolchildren's diabetes awareness and possibility to have a healthy body weight are important.

This study describes the development and psychometric evaluation of four scales measuring leadership for health promotion at an organizational level in the baseline survey (n = 144) of the Alberta Heart Health Project. Content validity was established through a series of focus groups and expert opinion appraisals, pilot testing of a draft based on capacity assessment instruments developed by other provinces involved in the Canadian Heart Health Initiative, and the literature. Psychometric analyses provided empirical evidence of the construct validity and reliability of the organizational leadership scales. Principal component analysis verified the unidimensionality of the leadership scales of (a) Practices for Organizational Learning, (b) Wellness Planning, (c) Workplace Climate, and (d) Organization Member Development. Scale alpha coefficients ranged between 0.79 and 0.91 thus establishing good to high scale internal consistencies. These measures can be used by both researchers and practitioners for the assessment of organizational leadership for health promotion and heart health promotion. (Contains 1 figure and 2 tables.)

Objective: The purpose of this study was to validate measures of individual and organisational infrastructure for health promotion within Alberta's (Canada) 17 Regional Health Authorities (RHAs). Design: A series of phases were conducted to develop individual and organisational scales to measure health promotion infrastructure. Instruments were designed with focus groups and then pre-tested prior to the validation study. Setting: In 1993 all hospitals and Public Health Units in the province of Alberta were regionalised into 17 RHAs, with responsibility for public health, community health, and acute and long-term care. While regionalisation may offer more opportunity for community participation, reorganisation of the public health system may have fragmented and diluted resources and skills for heart health promotion in some RHAs. Infrastructure (for example, human and financial resources), amongst other items, is believed to contribute to the capacity to promote health. Method: All 17 RHAs participated in the study, yielding a total of 144 individuals (that is board members, senior/middle management, and front line staff). These representative employees completed a self-administered questionnaire on individual- and organisational-level infrastructure measures. Results: Psychometric analyses of survey data provided empirical evidence for the robustness of the measures. Principal component analyses verified the construct validity of the scales, with alpha coefficients ranging from 0.75 to 0.95. Conclusion: The scales can be used by health professionals and researchers to assess individual- and organisational-level infrastructure, and tailor interventions to increase infrastructure for health promotion in health organisations. (Contains 4 tables.)

Introduction: The lack of policy, practice and research action on physical activity and features of the physical (built and natural) environments in rural, remote and northern settings is a significant threat to population health equity in Canada. This paper presents a synthesis of current evidence on the promotion of physical activity in non-urban settings, outcomes from a national priority-setting meeting, and a preliminary call to action to support the implementation and success of population-level initiatives targeting physical activity in non-urban settings. Methods: We conducted a "synopses of syntheses" scoping review to explore current evidence on physical activity promotion in rural, remote, northern and natural settings. Next, we facilitated a collaborative priority-setting conference with 28 Canadian experts from policy, research and practice arenas to develop a set of priorities on physical activity in rural, remote and northern communities. These priorities informed the development of a preliminary Canadian call to action. Results: We identified a limited number of reviews that focused on physical activity and the built environment in rural, remote and northern communities. At the prioritysetting conference, participants representing rural, remote and northern settings identified top priorities for policy, practice and research action to begin to address the gaps and issues noted in the literature. These priorities include self-identifying priorities at the community level; compiling experiences; establishing consistency in research definitions and methods; and developing mentorship opportunities. Conclusion: Coordinated action across policy, practice and research domains will be essential to the success of the recommendations presented in this call to action. [ABSTRACT FROM AUTHOR]

Background: Healthy public policy is an important tool for creating environments that support human health and wellbeing. At the local level, municipal policies, such as zoning bylaws, provide an opportunity for governments to regulate building location and the type of services offered. Across North America, there has been a recent proliferation of municipal bylaws banning fast food drive-through services. Research on the utilization of this policy strategy, including bylaw adopters and adopter characteristics, is limited within the Canadian context. The aim of this study was to identify and characterize Canadian municipalities based on level of policy innovation and nature of their adopted bylaw banning fast food drive-through services.Methods: A multiple case history methodology was utilized to identify and analyse eligible municipal bylaws, and included development of a chronological timeline and map of adopter municipalities within Canada. Grey literature and policy databases were searched for potential adopters of municipal fast food drive-through service bylaws. Adopters were confirmed through evidence of current municipal bylaws. Geographic diffusion and diffusion of innovations theories provided a contextual framework for analysis of bylaw documents. Analysis included assignment of adopter-types, extent and purpose of bans, and policy learning activities of each adopter municipality.Results: From 2002 to 2016, 27 municipalities were identified as adopters: six innovators and twenty-one early adopters. Mapping revealed parallel geographic diffusion patterns in western and eastern Canada. Twenty-two municipalities adopted a partial ban and five adopted a full ban. Rationales for the drive-through bans included health promotion, environmental concerns from idling, community character and aesthetics, traffic concerns, and walkability. Policy learning, including research and consultation with other municipalities, was performed by nine early adopters.Conclusion: This study detailed the adoption of fast food drive-through bylaws across Canada. Understanding the adopter-type characteristics of municipalities and the nature of their bylaws can assist other jurisdictions in similar policy efforts. While the implications for research and practice are evolving and dynamic, fast food drive-through service bans may play a role in promoting healthier food environments. Further research is required to determine the viability of this strategy for health promotion and chronic disease prevention. [ABSTRACT FROM AUTHOR]

Acculturation has been associated with decreased physical activity among immigrants. This study assessed the process of changing physical activity patterns within the context of Latin American immigrant women's migration experiences to Canada. Using the ecological model of health promotion, we applied a mixed methods research design. Thirty-six Latin American immigrant women, 18 recent (<10 years in Canada) and 18 non-recent (>10 years in Canada), participated. Six focus groups and 14 in-depth individual interviews were conducted. The Godin Leisure-Time Exercise Questionnaire was administered. Overall, 86 % of the participants reported gaining weight since coming to Canada. Participants reported becoming more sedentary upon arriving in Canada. Only 27.3 % of recent and 41.7 % of non-recent immigrant women were considered sufficiently physically active. Lack of time, resources, social support, and migration stress were identified as key barriers to physical activity. Migration stress associated with social integration barriers strongly influence physical activity among Latin American immigrant women. [ABSTRACT FROM AUTHOR]

Indigenous First Nations people in Canada have high chronic disease morbidity resulting in part from enduring social inequities and colonialism. Obesity prevention strategies developed by and for First Nations people are crucial to improving the health status of this group. The research objective was to develop community-relevant strategies to address childhood obesity in a First Nations community. Strategies were derived from an action-based workshop based on the Analysis Grid for Environments Linked to Obesity ( ANGELO) framework. Thirteen community members with wide-ranging community representation took part in the workshop. They combined personal knowledge and experience with community-specific and national research to dissect the broad array of environmental factors that influenced childhood obesity in their community. They then developed community-specific action plans focusing on healthy eating and physical activity for children and their families. Actions included increasing awareness of children's health issues among the local population and community leadership, promoting nutrition and physical activity at school, and improving recreation opportunities. Strengthening children's connection to their culture was considered paramount to improving their well-being; thus, workshop participants developed programmes that included elders as teachers and reinforced families' acquaintance with First Nations foods and activities. The research demonstrated that the ANGELO framework is a participatory way to develop community-driven health programmes. It also demonstrated that First Nations people involved in the creation of solutions to health issues in their communities may focus on decolonising approaches such as strengthening their connection to indigenous culture and traditions. External funds were not available to implement programmes and there was no formal follow-up to determine if community members implemented programmes. Future research needs to examine the extent to which community members can implement programmes on their own and whether community action plans, when implemented, lead to short- and long-term benefits in health outcomes. [ABSTRACT FROM AUTHOR]

The Alberta Policy Coalition for Cancer Prevention (APCCP) represents practitioners, policy makers, researchers, and community organizations working together to coordinate efforts and advocate for policy change to reduce chronic diseases. The aim of this research was to capture changes in the APCCP’s capacity to advance its goals over the course of its operation. We adapted the Public Health Agency of Canada’s validated Community Capacity-Building Tool to capture policy work. All members of the APCCP were invited to complete the tool in 2010 and 2011. Responses were analyzed using descriptive statistics and t tests. Qualitative comments were analyzed using thematic content analysis. A group process for reaching consensus provided context to the survey responses and contributed to a participatory analysis. Significant improvement was observed in eight out of nine capacity domains. Lessons learned highlight the importance of balancing volume and diversity of intersectoral representation to ensure effective participation, as well as aligning professional and economic resources. Defining involvement and roles within a coalition can be a challenging activity contingent on the interests of each sector represented. The participatory analysis enabled the group to reflect on progress made and future directions for policy advocacy. [ABSTRACT FROM PUBLISHER]

Background Nudging is an approach to environmental change that alters social and physical environments to shift behaviors in positive, self-interested directions. Evidence indicates that eating is largely an automatic behavior governed by environmental cues, suggesting that it might be possible to nudge healthier dietary behaviors. This study assessed the comparative and additive efficacy of two nudges and an economic incentive in supporting healthy food purchases by patrons at a recreational swimming pool. Methods An initial pre-intervention period was followed by three successive and additive interventions that promoted sales of healthy items through: signage, taste testing, and 30% price reductions; concluding with a return to baseline conditions. Each period was 8 days in length. The primary outcome was the change in the proportion of healthy items sold in the intervention periods relative to pre- and post-intervention in the full sample, and in a subsample of patrons whose purchases were directly observed. Secondary outcomes included change in the caloric value of purchases, change in revenues and gross profits, and qualitative process observations. Data were analyzed using analysis of covariance, chi-square tests and thematic content analysis. Results Healthy items represented 41% of sales and were significantly lower than sales of unhealthy items (p < 0.0001). In the full sample, sales of healthy items did not differ across periods, whereas in the subsample, sales of healthy items increased by 30% when a signage + taste testing intervention was implemented (p < 0.01). This increase was maintained when prices of healthy items were reduced by 30%, and when all interventions were removed. When adults were alone they purchased more healthy items compared to when children were present during food purchases (p < 0.001), however parental choices were not substantially better than choices made by children alone. Conclusions This study found mixed evidence for the efficacy of nudging in cueing healthier dietary behaviors. Moreover, price reductions appeared ineffectual in this setting. Our findings point to complex, context-specific patterns of effectiveness and suggest that nudging should not supplant the use of other strategies that have proven to promote healthier dietary behaviors. [ABSTRACT FROM AUTHOR]

This study explored facilitators and barriers to capacity building for chronic disease prevention (CDP) activities with participants in community-based workshops on environments related to CDP. Three phases of research were conducted. Worksheet analysis (Phase A) indicated that participants (n = 34) identified priority strategies related to the physical environment as a primary focus for CDP, followed by sociocultural, economic, and political environments. Questionnaire completion (Phase B; n = 17) indicated that individuals' capacity was inhibited by a lack of organizational infrastructure (particularly, resources and public and research support). Interviews (Phase C; n = 11) revealed five factors that limited participants' capacity: (a) organizations' lack of competing priorities, (b) priorities secondary to the organizational mandate, (c) disconnect between organizational and government or funder priorities, (d) limited resources, and (e) larger community issues. Implications for research and practice are discussed. [ABSTRACT FROM AUTHOR]

Native American Indians and First Nations are predisposed to obesity and diabetes. A study was done to understand Cree schoolchildren's diabetes awareness and body size perceptions in two communities that had diabetes awareness-raising activities in the Province of Quebec, Canada. Children (N = 203) in grades 4–6 were classified into weight categories using measured heights and weights and grouped on diabetes awareness based on dichotomous responses to the question ‘Do you know what diabetes is?’ Children selected a drawing of an American Indian child whom they felt most likely to get diabetes and described their body size perception using a closed response question. Although 64.5% of children were overweight or obese, most (60.1%) children considered their body size to be ‘just right’, with 29.6% considering it ‘too big’ and 10.3% considering it ‘too small’. A minority (27.6%) of children had diabetes awareness. These children were more likely than children without diabetes awareness to consider their body size too big (42.9 versus 24.5%) and to choose an obese drawing as at risk for diabetes (85.7 versus 63.3%, odds ratio 3.48 and 95% confidence interval 1.53–7.91). Culturally appropriate health education programs to increase schoolchildren's diabetes awareness and possibility to have a healthy body weight are important. [ABSTRACT FROM PUBLISHER]

This paper provides a baseline profile of organizational capacity for (heart) health promotion in Alberta's regional health authorities (RHAs); and examines differences in perceived organizational health promotion capacity specific to modifiable risk factors across three levels of staff and across capacity levels. Baseline data were collected from a purposive sample of 144 board members, senior/middle managers and service providers from 17 RHAs participating in a five-year time-series repeated survey design assessing RHA capacity for (heart) health promotion. Results indicate low levels of capacity to take health promotion action on the broader determinants of health and risk conditions like poverty and social support. In contrast, capacity for health promotion action specific to physiological and behavioural risk factors is considerably higher. Organizational “will” to do health promotion is noticeably more present than is both infrastructure and leadership. Both position held within an organization as well as overall level of organizational capacity appear to influence perceptions of organizational capacity. Overall, results suggest that organizational “will”, while necessary, is inadequate on its own for health promotion implementation to occur, especially in regard to addressing the broader determinants of health. A combination of low infrastructure and limited leadership may help explain a lack of health promotion action. (Promot Educ 2008;15(2): 6—14) [ABSTRACT FROM PUBLISHER]