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International student mobility amongst and between countries has become increasingly common and forms a central feature of the global higher education system. This paper examines the key learning experiences relating to the student mobility component of the Canadian-European Initiative for Health Promotion Advanced Learning (CEIHPAL) project. CEIHPAL was a unique and innovative project that fostered advanced intercontinental education and learning in health promotion from 2005–2008. With co-funding from the European Commission and the Canadian Government, the project facilitated institutional, student and faculty cooperation, by developing a high level of international communication. In particular, this paper focuses on the student mobility component and experiences of the CEIHPAL programme, a central part of the project activities. Feedback from both Canadian and European students themselves is used to document their participation in the programme, including the benefits derived from taking part as well ...

OBJECTIVES: Health care systems throughout the world are in the process of restructuring and reforming their health service delivery systems, reorienting themselves to a primary health care (PHC) model that uses multidisciplinary practice (MDP) teams to provide a range of coordinated, integrated services. This study explores the challenges of putting the MDP approach into practice in one community in a city in Canada. METHODS: The data we analyzed were derived from a community-based participatory action research (CBPAR) project, conducted in 2004, that was used to enhance collaborative MDP in a PHC center serving a residential and small-business community of 11 000 within a medium-sized city of approximately 300 000 people in Canada. CBPAR is a planned, systematic approach to issues relevant to the community of interest, requires community involvement, has a problem-solving focus, is directed at societal change, and makes a lasting contribution to the community. We drew from one aspect of this complex, multiyear project aimed at transforming the rhetoric advocating PHC reform into actual sustainable practices. The community studied was diverse with respect to age, socioeconomics, and lifestyle. Its interdisciplinary team serves approximately 3 000 patients annually, 30% of whom are 65 years or older. This PHC center's multidisciplinary, integrated approach to care makes it a member of a very distinct minority within the larger primary care system in Canada. RESULTS: Analysis of practice in PHC revealed entrenched and unconscious ideas of the limitations and boundaries of practice. In the rhetoric of PHC, MDP was lauded by many. In practice, however, collaborative, multidisciplinary team approaches to care were difficult to achieve. CONCLUSIONS: The successful implementation of an MDP approach to PHC requires moving away from physician-driven care. This can only be achieved once there is a change in the underlying structures, values, power relations, and roles defined by the health care system and the community at large, where physicians are traditionally ranked above other care providers. The CBPAR methodology allows community members and the health-related professionals who serve them to take ownership of the research and to critically reflect on iterative cycles of evaluation. This provides an opportunity for practitioners to implement relevant changes based on internally generated analyses.

OBJECTIVES: Health care systems throughout the world are in the process of restructuring and reforming their health service delivery systems, reorienting themselves to a primary health care (PHC) model that uses multidisciplinary practice (MDP) teams to provide a range of coordinated, integrated services. This study explores the challenges of putting the MDP approach into practice in one community in a city in Canada. METHODS: The data we analyzed were derived from a community-based participatory action research (CBPAR) project, conducted in 2004, that was used to enhance collaborative MDP in a PHC center serving a residential and small-business community of 11 000 within a medium-sized city of approximately 300 000 people in Canada. CBPAR is a planned, systematic approach to issues relevant to the community of interest, requires community involvement, has a problem-solving focus, is directed at societal change, and makes a lasting contribution to the community. We drew from one aspect of this complex, multiyear project aimed at transforming the rhetoric advocating PHC reform into actual sustainable practices. The community studied was diverse with respect to age, socioeconomics, and lifestyle. Its interdisciplinary team serves approximately 3 000 patients annually, 30% of whom are 65 years or older. This PHC center's multidisciplinary, integrated approach to care makes it a member of a very distinct minority within the larger primary care system in Canada. RESULTS: Analysis of practice in PHC revealed entrenched and unconscious ideas of the limitations and boundaries of practice. In the rhetoric of PHC, MDP was lauded by many. In practice, however, collaborative, multidisciplinary team approaches to care were difficult to achieve. CONCLUSIONS: The successful implementation of an MDP approach to PHC requires moving away from physician-driven care. This can only be achieved once there is a change in the underlying structures, values, power relations, and roles defined by the health care system and the community at large, where physicians are traditionally ranked above other care providers. The CBPAR methodology allows community members and the health-related professionals who serve them to take ownership of the research and to critically reflect on iterative cycles of evaluation. This provides an opportunity for practitioners to implement relevant changes based on internally generated analyses.OBJETIVOS: Los sistemas de salud de todo el mundo se encuentran en un proceso de reestructuración y reforma de sus sistemas de prestación de servicios, reorientándose hacia el modelo de atención primaria de salud (APS) que utiliza equipos de consultorios multidisciplinarios (CMD) para brindar un conjunto de servicios coordinados e integrados. En este estudio se exploran los retos de poner en práctica el enfoque de CMD en una comunidad urbana de Canadá. MÉTODOS:Los datos analizados se tomaron de un proyecto de investigación-acción participativa basada en la comunidad (IAPBC) llevado a cabo en 2004. Su objetivo era perfeccionar un CMD colaborativo en un centro de APS que atiende a una comunidad de 11 000 personas, compuesta por una zona residencial y pequeños negocios, en una ciudad canadiense de aproximadamente 300 000 personas. La IAPBC permite abordar de manera planificada y sistemática problemas importantes para la comunidad en cuestión, requiere la participación de la comunidad, se enfoca hacia la solución de los problemas, se dirige a lograr cambios en la sociedad y hace contribuciones duraderas a la comunidad. Se partió de un aspecto de este complejo proyecto de varios años, para transformar la defensa retórica de la reforma de la APS en una práctica real y sustentable. La comunidad estudiada era diversa en cuanto a la edad, las características socioeconómicas y los estilos de vida. Su equipo multidisciplinario atendía aproximadamente a 3 000 pacientes al año, 30% de los cuales tenían 65 años o más. Gracias a su enfoque multidisciplinario e integrado con respecto a la atención, este centro de APS pasó a formar parte de un selecto grupo dentro del extenso sistema de atención primaria de Canadá. RESULTADOS: El análisis del trabajo de APS puso de manifiesto ideas arraigadas e inconcientes acerca de los límites y las limitaciones de la atención prestada. En el sentido retórico de la APS, el CMD era elogiado por muchos. En la práctica, sin embargo, era difícil lograr el enfoque de equipo colaborativo multidisciplinario. CONCLUSIONES: La exitosa implementación de un enfoque de CMD en la APS exige apartarse del estilo de atención centrada en el médico. Esto sólo puede lograrse cuando cambian las estructuras subyacentes, los valores, las relaciones de poder y los papeles a desempeñar, definidos por los sistemas de salud y la comunidad en general, donde los médicos tienen tradicionalmente una posición por encima de la de otros proveedores de atención sanitaria. La metodología de IAPBC permite a los miembros de la comunidad y a los profesionales relacionados con la salud que los atienden apropiarse de la investigación y reflejarse críticamente en ciclos iterativos de evaluación. Esto ofrece a los médicos una oportunidad de implementar cambios importantes basados en análisis generados internamente.

The Canadian health care system is under increased pressure to reform. While some advocates lobby for more physicians and more resources to fix the ailing system, many reports point to another potential solution – implementing primary health care (PHC). Implementing PHC will not be easy. Even though there is substantial evidence to support the efficacy and cost effectiveness of PHC, its implementation will require substantial changes in practice. Community-based research (CBR) has the potential to be the catalyst for the type of change that is required. A multidisciplinary, multisectoral inquiry team has been funded to use CBR to reconceptualize and transform PHC service delivery in British Columbia, Canada. Although the research project is in its initial phase, it is anticipated that the research will provide new, holistic, and comprehensive frameworks for practice. This paper describes the process used to bring about these changes.

It is well known that gender is a determinant of health, but less understood is whether differences in health status attributable to gender can be mitigated through the implementation of primary health care. Primary health care, notably distinct from primary care, refers to a wide-ranging approach to the delivery of a comprehensive variety of health services. This article traces the similarities between primary health care and women-centred care from their overlapping philosophical foundations to the similar health, social, and economic benefits of both approaches. It is argued that investments in primary health care positively impact women's health, and, as such, should be a preferred option for the delivery of women's community health services. Several models of health service delivery that operate in accordance with principles of primary health care and also address the key tenets of women's-centred care are examined and their merits are compared. The article also identifies the major impediments to the adoption of both primary health care and women's-centred care approaches.

For non-profit social agencies, new contract funding structures have increased their vulnerability. Collaboration is a strategy for dealing with reductions in the availability of funding and the pressures to ‘do more with less’ but there are few illustrations of how this might be achieved. The main body of literature devoted to creating models for collaboration was developed in the world of the new public administration and market models. Many of the less formal approaches consist of checklists and mock contracts that strive to account for variables that may affect collaborations. While valuable for focussing attention on key aspects, these approaches assume a static set of factors that predict successful collaborations. In this project, an alternative to these types of functional or instrumental methods of partnership development was created through a particular type of action research known as co-operative inquiry. Through the iterative stages of reflection and action, a new conceptualization of collaboration evolved and a subsequent model developed. The model is based on criteria derived from the experiences of the community members and accounts for the dialectical relationship of the individual agency and the collective non-profit sector. Through the process of the research, a transformation in thinking, purpose and practice occurred, resulting in a new metaphor for living and working in the community.

The current systematic reviews to assess the effectiveness of community-based health promotion projects, be they quantitative (numerical meta-analyses) or qualitative (narrative reviews), both have significant drawbacks. Out of the work conducted for two initiatives, the developments for the Global programme on health promotion effectiveness carried at by the North American Region out of the International Union of Health Promotion and Education (IUHPE), as well as the work conducted for the ECIP (effectiveness of community interventions project) of Health Canada, a new way to approach the issue of effectiveness is proposed. Based on a «realist synthesis» epistemological position, this approach has led us to the first formulation of a framework aiming at identifying the mechanisms that explain why local programs are successful.

Research indicates that most self-care interventions and education strategies lead to an increase in self-care behaviours and more informed health decisions by participants. What is less clear from these studies is the type of information the public seeks to aid their decision making. For one year participants were asked to keep a health diary recording their health issues and what steps they took to solve them. The data from 153 health diaries containing 812 health issues were analysed. Analysis revealed the most frequent health issues, examples of decisions about self-care, information seeking behaviours and an indication of how and for what purpose participants used the self-care resources.

Arguments have been made in favour of a constructivist or postpositivist approach to health promotion knowledge development and program evaluation, but little has been articulated about what such an approach would look like. This article describes a 'story/dialogue method' that was created with and for practitioners in response to their concerns that much of their practice did not lend itself to a positivist, or conventional, methodology. Derived from constructivist, feminist and critical pedagogical theory, and with roots in qualitative methods, the method structures group dialogue around case stories addressing particular generative practice themes. While intended for practitioner training, organizational development and evaluation, the method to date has been used primarily for training purposes. This article describes the method, provides an example of its application, and discusses its strengths, weaknesses and relevance to health promotion.

Five schools of nursing in British Columbia formed a collaborative partnership in 1989; four represented diploma programs, and one a post-RN program. Their partnership benefited each in the development of a baccalaureate nursing curriculum. Committed to the principle of a curriculum being driven by practice, rather than the reverse, the collaborative partners employed a variety of strategies to include nurses from practice in the development of the curriculum. One strategy used by the partnership was a Delphi survey of nurses in practice. This article describes the results of this survey and their implications for nursing curricula.

The behavioral approach to curriculum development is inadequate to educate nurses to practice in the future health care system. As a result of a government initiative, a Canadian university and four community colleges had an opportunity to collaborate on development of a nursing program and thereby consider alternative approaches to curriculum development. This paper describes the process used to develop this curriculum and provides an overview of the curriculum development model that emerged. A community development process characterized by a commitment to be futuristic and visionary about nursing while making curriculum decisions was established. The curriculum model that emerged used a phenomenological exploration of our common vision for nursing in the future. The resulting curriculum is based on a human science paradigm that encourages nurses to work from a health promotion perspective with an ethic of caring.

The chapter is focused mainly on the intervention research and evaluation of actions aimed at strengthening and supporting health assets as a way of producing healthy communities and individuals. There is a need to re-think traditional assumptions related to evaluating the effectiveness of health interventions aimed at strengthening health assets as opposed to eliminating or curing diseases. Working from a concrete example of a 4-year collaborative project in Canada aimed at developing a framework for evaluating the effectiveness of community interventions to promote health and build community capacity. The chapter introduces a series of profound methodological challenges that this type of evaluation research presents, along with a discussion of the attempt to use a ‘realist synthesis’ approach to addressing these challenges.

We argue that policies for women-centred care ought to be developed to address the inadequacy of the current health system to recognize that women are affected differently by health policies and programs and that gender is a determinant of health; furthermore, such policies must be created with representatives from relevant health professional organizations so that the policies are translated and operationalized at the organizational and practice level. A collaborative research process, co-operative inquiry, was used to conduct the research. This process engages the participants in rigorous iterations of action and reflection. The result was a clear definition of women-centred care, a set of general guidelines for practice, and specific changes to existing organizational policies. The process and the product of the research built a bridge between existing macro government policies and the guidelines, standards, and ethical codes of the professional health associations.

What we now think of as the field of health promotion has grown rapidly in the last 15 years, mainly out of the field of health education. With this expansion, has come the need to develop education and training programmes for current and future health promotion practitioners.

It has become evident that the current approaches to health care are inadequate for the changing needs of the world. Health promotion has gained recognition as a preferred option and many nursing programmes throughout the world have reoriented their curricula to incorporate this approach. This paper describes a study that was conducted to explicate student experiences of the practice of health promotion. Twenty-four students participated in the study; qualitative methods, narrative accounts and reflective journals were used to collect the data and the data was analysed using van Manen's recommendations for thematic analysis. Three major themes emerged: the centrality of caring; empowerment--power, participation and partnerships; and the primacy of people. Student narratives are used to illustrate the themes.

Health care will be increasingly focused on the principles of health promotion and primary health care to better meet society's health needs. Nursing has an opportunity to lead the way in primary health care, however, for nurses to realize their potential, educational programs must be radically revised and be developed to teach nurses to work from a health-promotion perspective. Only when nurses have fully incorporated the principles of health promotion into their repertoire of working with clients and colleagues will they be the desired and appropriate profession to lead health care into the future.

The interpersonal skills demonstrated by a nurse affect the quality of care delivered to patients. The patients’ sense of wellbeing and the nurses’ understanding of patient response to medical treatment result from such interpersonal care. The present study was a response to the view that a clear description of the interpersonal skills of practicing nurses is needed to provide a basis for planning the curriculum for training nurses. Available components exist for developing the interpersonal skills of helping professionals but, typically, have not been utilized in nursing education. Most training programs deal with such skills at the conceptual level, providing little or no skill demonstration or assessment. Consideration of such training programs is important because effective interpersonal skills were once thought to be the unique tool of psychiatric nurses, but are currently viewed by such authors as Pluckman (1978) as necessary tools of all professional nurses regardless of area of practice. Initial interactions between nurses and patients on a general medical-surgical unit were selected for study because such interactions establish a basis for effective helping (Combs et al., 1978). Patients’ requests or reactions typically require an instantaneous response from nurses. Interactions which are characterized by empathy, warmth and respect are considered to facilitate the development of the nurse-patient relationship (Pluckman, 1978; Watson, 1979). In a majority (89%) of studies of patient outcomes reviewed by Gerrard (1978), positive patient responses were shown to be related to the interpersonal skills of health professionals. Such responses included relief from pain and distress, improved pulse and respiration rates, and patient reports of reduced worry and anxiety. In an early study of nurses’ interpersonal skills, Mathews (1962) had 122 staff nurses respond to nine simulated nurse-patient situations in a questionnaire format. Only eight nurses in her sample gave responses which encouraged the patient to disclose what he was experiencing. In a later study by Hays (1966), nurses were asked to write verbatim notes

The argument is presented that personal integration and transfer of interpersonal skills is more likely to occur if significant attention is given to the learning phase of skills training. Guidelines are presented to help trainers create conditions that encourage learners to discover the personal meaning of these skills. These guidelines are part of an integrative approach that seeks to acknowledge what learners bring to training, to encourage learners to respect their own abilities and reactions to training, and to coach learners to use skills in ways that fit their individual styles and contexts.

Improvements in transfer and retention of skills learned in parent education programs were hypothesized to occur if the learning process provided for the "discovery of personal meaning" (Combs, 1982). Twenty-eight mothers and fathers were randomly assigned to programs emphasizing either a personal meaning approach or a traditional approach. Communica tion skills were assessed from videotaped encounters with parents' own children at home at three times: pretest, posttest, and 6-week follow-up. A ttitudinal measures were also administered. Parents in the personal meaning approach demonstrated more effective learning and retention. Few changes in attitude or self-concept occurred.