7. Linking Research and Practice - I
As explained in the conceptual framework, Mujer Sana/Comunidad Sana used a participatory action research approach. Participants from the Hispanic community were involved from the outset in the design of the project as members of LAZO. The Lay Health Promoters/Participatory Researchers (LHP/PRs) participated on all project committees including the research committee provided input into research design; helped develop data collection tools, and collected, analyzed, and reported on research findings, as part of their job in the Human Resources section}. One of the key partner organizations, Centretown Community Health Centre, which participated on an equal basis with other partners, was also a focus of research as a case study, and a target for change.
Benefits of linking research and practice
The direct links between research tasks and health promotion programming became more evident to all members of the project as it unfolded. For example, questions raised by women with whom LHP/PRs were in contact, and issues identified by the community through committee input, were reflected whenever possible in questions asked in the research, influenced the design of tools and strategies, and helped set priorities for analysing results. The skills that LHP/PRs learned, to undertake successful open-ended in-depth research interviews, were directly applicable to one-on-one health promotion contacts with other women in the community. In the process of surveying the community, Lay Health Promoters/Participatory Researchers also took the opportunity to determine the stage of change for each woman surveyed in relation to breast and cervical screening, and responded with appropriate health information, support strategies, and referrals based on each woman's needs. As another example, data collected from people attending the health festival provided insights into which of the LHP/PRs' outreach techniques had worked best to attract women to attend this event, and led to skills exchange and improved strategies among the LHP/PRs. Preliminary analysis of the community survey led to identification of other areas of health need in the community (such as diabetes, depression), which helped the transfer and sustainability committee to set priorities for future activities. Review of charts at the Centretown Community Health Centre led to changes in the recording practices for primary care practitioners, with more specific information being collected in relation to breast cancer education.
Evaluation design
The evaluation design reflects the type of program that was being evaluated. Since the Mujer Sana - Comunidad Sana project was exploratory and participatory, the evaluation was exploratory and participatory. Evaluation activities were ongoing: For example, after a first successful community workshop, LHP/PRs and the supporting Health Promoter learned how to use the evaluation research strategy of designing logic models and post-workshop survey forms. This helped them prepare for the next workshops, and collect more useful and precise data. Results from evaluation of the training, events and activities were summarized and discussed as quickly as possible after each event. In combination with preliminary results from the community surveys, interviews, and chart reviews, this provided ongoing feedback to the design of the next set of outreach and program activities.
Team meetings
The group of LHPs met on a weekly basis to assess practice and plan the next steps. We designed evaluation mechanisms for each programming activity, such as events, workshops, shopping centre displays, ESL classes, individual contacts, and presentations. The first step always consisted of participatory discussions to clarify the main objectives: what do we hope to achieve? Next, we would determine what was the best way to find out if we had achieved those objectives; priorize what information we would collect, and decide how (for example, survey participants; observe what people are doing; interview each other). After each event we then were able to determine if our objectives were reached. By working in a participatory way, we often were able to identify unexpected effects of an activity, and understand the context and circumstances which affected outcomes. As a result, evaluation data was collected throughout the project. Workplans were adjusted given new insights. For example, a mid-point detailed review of LHP/PRs' health promotion activities suggested that many had focused more on group outreach, conducting workshops and presentations, than on individual follow-ups. As a result, the following months we concentrated resources on supporting individual follow-up activity with women, to provide health information, teach BSE (breast self examination) and assess whether or not women had been able to go to their annual check-ups.
For more information on research and practice, go to research tasks and health promotion tasks.
