7. Linking Research and Practice - III
Research Task
Interview reflection and follow-up notes
After each interview, the LHP/PRs used a form (including both open and closed items), to narrate their reflections about each interview, assess the need for information or support in relation to cancer screening behaviour, and identify any additional issues, needs, or problems mentioned. This information was used to help the LHP/PR to make a follow-up contact plan, send more information, or refer her to services in the community. Two LHP/PRs worked with a co-investigator to code and quantify information from the interview reflection notes, and entered the data into an Excel data base that they helped to develop. The whole LHP/PR team reviewed the summarized information, and participated in group discussions to analyze some of the findings and understand better the types of problems that lay health promoters working with marginalized women might encounter.
Go to Findings from interviews and surveys with Hispanic women for more information about the results.
Activity Logs
All LHP/PRs kept monthly logs in Spanish about the activities they carried out as part of this project. A number of different formats for these logs were developed and adapted throughout the history of the project. The key areas for reflection included outreach and contacts with women; work in the community; work within the partnership; team building; and personal growth and challenges. The logs were one more element in the ongoing training of LHP/PRs. They helped the LHP/PRs to understand the importance of documenting and reflecting on their practice. At the beginning, the LHP/PRs found it difficult to keep track of the different forms used to document their activities. By the end, not only had their reporting skills improved, but they also understood how important it was for the project, and for others, to keep track of how their practice unfolded. The logs were analyzed, using both quantitative and qualitative methods. They have proved a rich source of information about referral systems, the response of institutions, the development of a working team, relations to the community centre, the response of the community, and outreach strategies with the community. See key findings for more details.
CCHC client intake
The health promotion activities were expected to have a positive impact on the number of Hispanic women who went to the Community Health Centre. We needed to collect information on CCHC clients (both clinical and health promotion sides) before we began the project, and compare it with the clients that were served during and after the project. To this end, we reviewed intake forms, both pre- and post- intervention. Data collection at CCHC was challenging, and a number of unforeseen technical issues arose, which nevertheless were resolved successfully. For instance, Mujer Sana/Comunidad Sana was unable to directly access the information systems and databases used by CCHC to keep track of clients and activities; neither were the systems designed to respond promptly and with sufficient precision to meet the project's data analysis needs. The project eventually had to develop its own database, and a separate system for data entry and data analysis (requiring separate re-entry of all relevant chart information, and of intake sheet information for all clients). Awareness of some of the limitations in the system at CCHC may lead to positive changes and improvements within the information systems at the centre (see case study results, in key findings. Another challenge was that the mother tongue and ethnicity data routinely collected by CCHC was not comparable with Census 2001 categories. The standard intake forms were adapted to reflect those categories, and are now used for all new clients. This will make it possible in future for CCHC to better compare its clientele to the residents in its catchment area along important variables such as race and mother tongue.
As of January 2003, we have successfully entered intake data on "Well Woman Check-ups", mother tongue, and ethnicity data from 735 primary care CCHC clients, and mother tongue and ethnicity data from 574 clients attending health promotion activities. Post-intervention data entry continues until March 2003, for analysis once the demonstration phase of the project is completed (see key findings).
Chart review
An important measure of the project's impact on CCHC is that more Hispanic women will be receiving a "Well Woman Check-up", which includes breast and cervical cancer screening and referral. With co-operation from staff nurses and a Hispanic research assistant, we reviewed the charts of all women who had received a 'Well Women Check-up' at CCHC in the year before the project started. An unexpected difficulty was that the CCHC doctors' practices were closed to new patients between September and December of 2001, due to a physician shortage. Recognizing the importance of ensuring that access of new clients to primary care continue to be available to the Hispanic community during the time of the project, CCHC made an exception for referrals from Mujer Sana. A nurse practitioner would see these women. The closure, however, required adjustment in data collection and analysis strategies.
At the outset of the chart review it also became evident that each doctor and nurse practitioner had a different method for noting and documenting their practices on breast and cervical screening and referral in the 'well woman check up' forms. The co-investigators interviewed the primary care practitioners, made suggestions, and invited input from the head of the primary care program, to determine whether recording methods could not be changed to accommodate the documentation needs of the project. Medical practitioners were very open to collaborate with the project, and agreed to use a new check-list in addition to their own 'well woman check up' to record information about clinical breast examination, referrals to mammograms, and pap-test. This is another example of the ongoing dialogue between research and practice in this project.
OBSP client intake
Another measure of the project's impact was that more Hispanic women over age 50 were going for screening mammograms. The Ontario Breast Screening Program (OBSP) is one of the key organizations offering this publicly-funded service in Ottawa. The program was an important collaborator with the Mujer Sana - Comunidad Sana project. We wanted baseline data on the clients served at OBSP prior to the implementation of the project, to compare it with clients served during, and after, the demonstration phase of the project. Unfortunately, baseline data on mother tongue and ethnicity was not available, since OBSP did not ask these questions in their intake forms. The OBSP, however were willing to add an additional form to their regular intake forms, to collect mother tongue and ethnicity data for all women accessing the program. This new form was available in Spanish, French and English. Data collection at the Ontario Breast Screening Program (OBSP) progressed very well. Over 2000 client forms were entered into an SPSS data base. Data collection for Mujer Sana -Comunidad Sana project will continued until March 2003. See key findings.
