Development of measures of organizational leadership for health promotion.

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.     

Baseline assessment of organizational capacity for health promotion within regional health authorities in Alberta, Canada

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.     

Towards the development of scales to measure 'will' to promote heart health within health organizations in Canada

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.     

Building capacity for heart health promotion: results of a 5-year experience in Nova Scotia,Canada

PURPOSE: To present the outcomes of a capacity-building initiative for heart health promotion. DESIGN: Follow-up study combining quantitative and qualitative methods. SETTING: The Western Health Region of Nova Scotia, Canada. SUBJECTS: Twenty organizations, including provincial and municipal agencies and community groups engaged in health, education, and recreation activities. INTERVENTION: Two strategies were used for this study: partnership development and organizational development. Partnership development included the creation of multilevel partnerships in diverse sectors. Organizational development included the provision of technical support, action research, community activation, and organizational consultation. MEASURES: Quantitative data included number and type of partnerships, learning opportunities, community activation initiatives, and organizational changes. Qualitative data included information on the effectiveness of partnerships, organizational consultation, and organizational changes. RESULTS: Results included the development of 204 intersectoral partnerships, creation of a health promotion clearinghouse, 47 workshops attended by approximately 1400 participants, diverse research products, implementation of 18 community heart health promotion initiatives, and increased organizational capacity for heart health promotion via varied organizational changes, including policy changes, fund reallocations, and enhanced knowledge and practices. CONCLUSIONS: Partnership and organizational development were effective mechanisms for building capacity in heart health promotion. This intervention may have implications for large-scale, community-based, chronic-disease prevention projects.     

Facilitators and challenges to organizational capacity building in heart health promotion

The authors describe the facilitators and challenges to a multi-sectoral initiative aiming at building organizational capacity for heart health promotion in Nova Scotia, Canada. The research process was guided by participatory action research. The study included 21 organizations from diverse sectors. Participant selection for the data collection was purposive. The authors collected data through organizational reflection logs and one-to-one semistructured interviews and used grounded theory techniques for the data analyses. Factors influencing organizational capacity for heart health promotion varied, depending on the project stage. Nonetheless, leadership, organizational readiness, congruence, research activities, technical supports, and partnerships were essential to capacity-building efforts. Approaches to organizational capacity building should be multi-leveled, because organizations are influenced by multiple social systems that are not all equally supportive of capacity.     

Using health promotion outcomes in formative evaluation studies to predict success factors in interventions: an application to an intervention for promoting physical activity in Dutch children (JUMP-in)

JUMP-in is a systematically developed intervention aimed at promoting physical activity among primary school children. It is a joint project involving different authorities and entails six school-based programme components. Measuring effects of such an intervention is a complex challenge. A common problem is the lack of valid instruments to measure physical activity and its determinants. In addition, it usually takes years to find improvements in physical activity and related constructs like weight and fitness, or even in causal factors. For this reason different authors advocate for the establishment of 'health promotion outcomes'; (i) health literacy, (ii) social action and influence and (iii) healthy public policy and organizational practice. It is presumed that these health promotion outcomes lead to changes in determinants, behaviour and finally in health. Insight in these health promotion outcomes and information about input and through-put are important in discussing the impact and output. The formative evaluation study of the JUMP-in pilot shows the health promotion outcomes of the intervention. The health promotion outcomes 'social action and influence' and 'healthy public policy and organizational practices' were found to be positive. By measuring the presence of the conditions to achieve 'health literacy', it became clear that more attention must be paid to implementation in the future. Based on the health promotion outcomes, we expect that JUMP-in will be an effective intervention in the future.     

Determinants of implementing heart health: promotion activities in Ontario public health units: a social ecological perspective

This paper reports the results of a study undertaken to explain levels of implementation of heart health promotion activities observed in Ontario public health agencies in 1997. Organizational-level data were collected by surveying all 42 health departments in 1994, 1996 and 1997 as part of the Canadian Heart Health Initiative Ontario Project. Guided by social ecological and organizational theories, the model examines relationships between implementation and four sets of possible determinants of activity: (1) the predisposition of agencies to undertake heart health promotion activities, (2) their capacity to undertake these activities, (3) internal organizational factors and (4) external system factors. A small set of five variables explains almost half of the variance in implementation (R2 = 0.46): organizational capacity (beta = 0.40), priority given to heart health (beta = 0.36), coordination of programs (beta = 0.19), use of resource centers (beta = 0.12) and participation in networks (beta = 0.09). The results suggest that models integrating organizational and socio-ecological theories can help us understand the implementation of community-based heart health promotion activities by public health agencies. Implications for future research, policy and practice are discussed.     

Development of measures of individual leadership 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.     

Organizational leadership and its relationship to regional health authority actions to promote health.

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.     

Diagnosis of sustainable collaboration in health promotion – a case study

Background  

Collaborations are important to health promotion in addressing multi-party problems. Interest in collaborative processes in health promotion is rising, but still lacks monitoring instruments. The authors developed the DIagnosis of Sustainable Collaboration (DISC) model to enable comprehensive monitoring of public health collaboratives. The model focuses on opportunities and impediments for collaborative change, based on evidence from interorganizational collaboration, organizational behavior and planned organizational change. To illustrate and assess the DISC-model, the 2003/2004 application of the model to the Dutch whole-school health promotion collaboration is described.     

Organizational capacity and implementation change: a comparative case study of heart health promotion in Ontario public health agencies

This paper reports the results of a comparative case study that examines factors influencing changes in implementation of heart health promotion activities in Ontario public health units. The study compared two cases that experienced large changes in implementation from 1994 to 1996, but in opposite directions. Multiple data sources were used, with an emphasis on secondary analyses of quantitative surveys of health units and other community agencies, and in-depth interviews of public health staff, collected as part of the Canadian Heart Health Initiative Ontario Project. Guided by social ecological and organizational theories, changes in implementation were explained by examining changes in (1) organizational predisposition to undertake heart health promotion activities, (2) organizational practices to undertake these activities, (3) other internal organizational factors and (4) external system factors. Findings show that in communities with diverse characteristics, implementation change was most strongly influenced by an interplay of changes in internal features of public health agencies; notably, leadership, structure and staff skills. Findings support a social ecological approach to health promotion by demonstrating the importance of the institutional context in the implementation change process, the interaction of individual (skills) and organizational (structure) levels in explaining implementation change, and community context in shaping the change process. Findings also reinforce the value of strengthening capacity within public health agencies and suggest further research on the implementation change process, especially in different systems and over longer periods of time.     

An organization-based intervention to improve support for employee heart health

PURPOSE: The purpose of this study was to evaluate the effectiveness of a management training seminar, developed through a partnership among a college, a managed care company, and a state public health department, to increase the level of organizational support for employee heart health in selected companies. DESIGN: Quasiexperimental. SETTING: Worksites, including heavy and light industries, school districts, insurance companies, county health agencies, and health care centers. SUBJECTS: Twenty western New York companies matched on size, industry type, and interest in worksite health promotion. INTERVENTION: Seven training seminars held at a college for 1 year and directed primarily at human resource managers. Training was supplemented by the availability of student interns, faculty consulting, a vendors' fair, and various program planning aids. MEASURES: Groups were assessed using HeartCheck, a measure of organizational support for employee heart health. RESULTS: A fourfold difference in change for HeartCheck was observed by the experimental vs. comparison groups (p < .01), along with significantly greater increases on five of the instrument's six subscales (p < .05). The level of HeartCheck reached in the experimental group matched those seen in highly acclaimed commercially sponsored programs. CONCLUSION: This study represents one of the first attempts to intervene at the organizational level within a worksite health promotion initiative. Positive results were observed that appear to be both meaningful and cost-effective.     

Issues in measuring health promotion capacity in Canada: a multi-province perspective

Significant international progress has been made researching and addressing the economic and social burden of cardiovascular disease, advanced particularly by international conferences and subsequent declarations, and the Canadian Heart Health Initiative (CHHI). The implementation focus of the CHHI on building capacity for heart health promotion is paralleled by efforts to measure capacity. Through the collective experience of Heart Health Programs in Nova Scotia, Saskatchewan, Alberta and British Columbia, critical issues in measuring health promotion capacity are identified and strategies for addressing them are presented. The provincial contexts for the programs vary, as do the conceptualizations of capacity and intervention strategies to build capacity. Yet, despite such differences across provinces, shared issues influencing measuring capacity number many. These include: multiple understandings of terms; evolving understanding of capacity; invisibility of capacity building; detecting change within a dynamic system; staff turnover; time course required for change; attribution for change in capacity; understanding a process through 'snap-shot' measurements; lack of existing 'gold standard' measurement tools; validity and credibility of instruments; evolving nature of measurement tools; gathering perspectives from multiple levels within organizations; dealing with conflicting perspectives; and managing and disseminating sensitive data. A number of strategies have been devised or adopted to address measurement issues, ranging from adopting participatory processes to the development of monitoring systems. Understanding and addressing issues in measuring capacity deserve attention as they may be potent influences in the dynamic interplay between research and intervention in the process of capacity building in the context of health promotion generally, and/or heart health specifically.     

Organizational health promotion: broadening the horizon of workplace health promotion

This article argues that efforts to improve the health and well-being of the workforce should begin with the organization itself. The term organizational health promotion is introduced to expand the scope of worksite health promotion. Organizational health promotion delves into the basic structural and organizational fabric of the enterprise--to how work is organized. The core themes of healthy work organization are introduced, and the status of our ability to identify organizational risk factors is discussed. A conceptual model of healthy work organization is presented, along with a process for expanding the health promotive capacity of the organization. The final section addresses challenges related to adopting an organizational health promotion perspective.     

Measuring the diffusion of innovative health promotion programs

Once a health promotion program has proven to be effective in one or two initial settings, attempts may be made to transfer the program to new settings. One way to conceptualize the transference of health promotion programs from one locale to another is by considering the programs to be innovations that are being diffused. In this way, diffusion of innovation theory can be applied to guide the process of program transference. This article reports on the development of six questionnaires to measure the extent to which health promotion programs are successfully disseminated: Organizational Climate, Awareness-Concern, Rogers's Adoption Variables, Level of Use, Level of Success, and Level of Institutionalization. The instruments are being successfully used in a study of the diffusion of health promotion/tobacco prevention curricula to junior high schools in North Carolina. The instruments, which measure the four steps of the diffusion process, have construct validity since they were developed within existing theories and are derived from the work of previous researchers. No previous research has attempted to use instruments like these to measure sequentially the stages of the diffusion process.     

Measuring worksite resources for employee heart health

PURPOSE: Intervention at the organizational rather than the individual level is gaining greater attention in worksite health promotion efforts. However, little research has been done on instruments to measure this domain. Therefore, the purpose of this study was to further test the utility of an existing organizational heart health support instrument by examining relationships among worksite structural characteristics and comparing these results to other survey findings. DESIGN: One-time cross-sectional. SETTING: New York State. SUBJECTS: One hundred fifteen volunteer worksites in the New York State Healthy Heart Program, representing manufacturing, government, education, health care, and other industries. MEASURES: A survey was conducted using HeartCheck, an organizational assessment of employee support for heart health. HeartCheck contains 175 items measuring organizational support for tobacco control, nutrition, physical activity, stress, screening, and administrative support structure. RESULTS: On average, only 22% of all worksite resources assessed were present in the sample. Having a workforce greater than 250 provided a 12% increase in predicted overall worksite resources. A predominantly female workforce (> 75%) provided 10% higher levels of worksite stress resources. Worksites with unions had higher levels of resources for physical activity (10%), screening (13%), and general supportive structures (10%). The presence of manual labor diminished support for tobacco control resources (-13%). Finally, manufacturing worksites demonstrated a clear advantage for all types of worksite resources, except for stress. CONCLUSION: A number of trends found in this study are consistent with earlier work. Industry type and size both predict worksite supports similar to previous studies. Other findings that appear to contradict previous work, including the relatively low level of support observed in this sample, can be explained by the comprehensive nature of the instrument. Overall, these findings demonstrate the utility of HeartCheck.     

The implementation of a cardiovascular school health promotion program: utilization and impact of a school health advisory committee: the Heart Smart program

A multidisciplinary school health advisory committee was developed to enhance acceptance and support for a total elementary school cardiovascular health promotion program (Heart Smart). Composed of teachers, school lunch personnel, physical educators and parents, this coalition served as a liaison between the school and project investigators, providing feedback on program acceptability. As an environmental support mechanism to the Heart Smart intervention, the group was additionally charged with designing and implementing adjunct health promotion activities within the school. The interactive nature of this committee, coupled with self-directed goal setting, provides a school model for institutionalizing health promotion, providing school personnel and parents with program ownership, and reinforcing school commitment to heart health. The theoretical and organizational framework used in implementing a health advisory committee is described.     

An examination of the stages of change construct for health promotion within organizations.

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.     

Organizational change--key to capacity building and effective health promotion

Contemporary health promotion is now a well-defined discipline with a strong (albeit diverse) theoretical base, proven technologies (based on program planning) for addressing complex social problems, processes to guide practice and a body of evidence of efficacy and increasingly, effectiveness. Health promotion has evolved principally within the health sector where it is frequently considered optional rather than core business. To maximize effectiveness, quality health promotion technologies and practices need to be adopted as core business by the health sector and by organizations in other sectors. It has proven difficult to develop the infrastructure, workforce and resource base needed to ensure the routine introduction of high-quality health promotion into organizations. Recognizing these problems, this paper explores the use of organizational theory and practice in building the capacity of organizations to design, deliver and evaluate health promotion effectively and efficiently. The paper argues that organizational change is an essential but under-recognized function for the sustainability of health promotion practice and a necessary component of capacity-building frameworks. The interdependence of quality health promotion with organizational change is discussed in this paper through three case studies. While each focused on different aspects of health promotion development, the centrality of organizational change in each of them was striking. This paper draws out elements of organizational change to demonstrate that health promotion specialists and practitioners, wherever they are located, should be building organizational change into both their practice and capacity-building frameworks because without it, effectiveness and sustainability are at risk.     

Design principles for data- and change-oriented organisational analysis in workplace health promotion

This article focuses on organizational analysis in workplace health promotion (WHP) projects. It shows how this analysis can be designed such that it provides rational data relevant to the further context-specific and goal-oriented planning of WHP and equally supports individual and organizational change processes implied by WHP. Design principles for organizational analysis were developed on the basis of a narrative review of the guiding principles of WHP interventions and organizational change as well as the scientific principles of data collection. Further, the practical experience of WHP consultants who routinely conduct organizational analysis was considered. This resulted in a framework with data-oriented and change-oriented design principles, addressing the following elements of organizational analysis in WHP: planning the overall procedure, data content, data-collection methods and information processing. Overall, the data-oriented design principles aim to produce valid, reliable and representative data, whereas the change-oriented design principles aim to promote motivation, coherence and a capacity for self-analysis. We expect that the simultaneous consideration of data- and change-oriented design principles for organizational analysis will strongly support the WHP process. We finally illustrate the applicability of the design principles to health promotion within a WHP case study.