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Network analysis of inter-organizational relationships and policy use among active living organizations in Alberta, Canada.

ABSTRACT: Coordinated partnerships and collaborations can optimize the efficiency and effectiveness of service and program delivery in organizational networks. However, the extent to which organizations are working together to promote physical activity, and use physical activity policies in Canada, is unknown. This project sought to provide a snapshot of the funding, coordination and partnership relationships among provincial active living organizations (ALOs) in Alberta, Canada. Additionally, the awareness, and use of the provincial policy and national strategy by the organizations was examined.Provincial ALOs (N = 27) answered questions regarding their funding, coordination and partnership connections with other ALOs in the network. Social network analysis was employed to examine network structure and position of each ALO. Discriminant function analysis determined the extent to which degree centrality was associated with the use of the Active Alberta (AA) policy and Active Canada 20/20 (AC 20/20) strategy.The funding network had a low density level (density = .20) and was centralized around Alberta Tourism Parks and Recreation (ATPR; degree centralization = 48.77%, betweenness centralization = 32.43%). The coordination network had a moderate density level (density = .31), and was low-to-moderately centralized around a few organizations (degree centralization = 45.37%, betweenness centrality = 19.92%). The partnership network had a low density level (density = .15), and was moderate-to-highly centralized around ATPR. Most organizations were aware of AA (89%) and AC 20/20 (78%), however more were using AA (67%) compared to AC 20/20 (33%). Central ALOs in the funding network were more likely to use AA and AC 20/20. Central ALOs in the coordination network were more likely to use AC 20/20, but not AA.Increasing formal and informal relationships between organizations and integrating disconnected or peripheral organizations could increase the capacity of the network to promote active living across Alberta. Uptake of the AA policy within the network is high and appears to be facilitated by the most central ALO. Promoting policy use through a central organization appeared to be an effective strategy for disseminating the province-level physical activity policy and could be considered as a policy-uptake strategy by other regions.

SUBMITTER: Loitz CC

PROVIDER: S-EPMC5550942 | biostudies-other | 2017 Aug

REPOSITORIES: biostudies-other

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Project description:BackgroundEfforts have been made by health research granting agencies to bring research closer to patients' concerns. In Canada, such efforts were formalized in 2011 with the funding of the Strategy for Patient-Oriented Research (SPOR)'s research networks to address research priorities identified by patients and accelerate the translation of research findings into patient care and health care policy. Among these networks, SPOR Diabetes Action Canada (DAC) has created patient-partner circles to facilitate their integration within the network. The nature of the relationships within this atypical patient-oriented research network is systematically explored in this paper.MethodsA cross-sectional social network study was conducted among the SPOR DAC's network members to examine inter-individual interactions, and the topics discussed the most between members. Descriptive data analyses were conducted to explore which discussion topics were discussed most among members whose primary roles were research, administration, governance, and patient representation.ResultsThe response rate was 51.9%, providing data on 76.5% of the maximum number of connections in the network. The survey captured 2763 inter-individual relationships. Responses to a sub-question inserted in the survey show that 482 of these relationships (17,4%) existed before joining the network in collaboration on a research project. Most ties captured in the survey were yearly or quarterly, while few relationships were monthly, weekly, or daily. In measured relationships, members discussed several topics, the most frequent being scientific research, patient engagement, network coordination and governance, and operations and management. The topics associated with the most significant proportion of relationships captured in the survey were scientific research (45.4%) and patient engagement (40.7%). Management & operations and governance & coordination follow, corresponding to 24.3 and 23.9% of the captured relationships. All discussion topic subnetworks were either somewhat or highly centralized, meaning that relationships were not equally distributed among members involved in these discussions. Of the 1256 relationships involving exchanges about scientific research, 647 (51.5%) involved a researcher, 419 (33.3%) an administrator, 182 (14.5%) a patient partner, and 82 (6.5%) a member whose primary role is network governance.ConclusionsScientific research and patient engagement were the most common topics discussed, consistent with the patient-centered research at the heart of the SPOR Diabetes Action Canada network. The study identified several relationships where a patient partner has discussed scientific research with a researcher. However, relationships involving research discussions were three times more common between a researcher and an administrator than between a researcher and a patient partner, although twice as many patient partners as administrators participated in the survey. The institutionalization of patient-partner involvement in large research networks is an evolving practice for which optimal engagement methods are still being explored.

Project description:IntroductionPreventative strategies that focus on addressing the social determinants of health to improve healthy eating and physical activity have become an important strategy in British Columbia and Ontario for combating chronic diseases. What has not yet been examined is the extent to which healthy living initiatives implemented under these new policy frameworks successfully engage with and change the social determinants of health.MethodsInitiatives active between January 1, 2006 and September 1, 2011 were found using provincial policy documents, web searches, health organization and government websites, and databases of initiatives that attempted to influence to nutrition and physical activity in order to prevent chronic diseases or improve overall health. Initiatives were reviewed, analyzed and grouped using the descriptive codes: lifestyle-based, environment-based or structure-based. Initiatives were also classified according to the mechanism by which they were administered: as direct programs (e.g. directly delivered), blueprints (or frameworks to tailor developed programs), and building blocks (resources to develop programs).Results60 initiatives were identified in Ontario and 61 were identified in British Columbia. In British Columbia, 11.5% of initiatives were structure-based. In Ontario, of 60 provincial initiatives identified, 15% were structure-based. Ontario had a higher proportion of direct interventions than British Columbia for all intervention types. However, in both provinces, as the intervention became more upstream and attempted to target the social determinants of health more directly, the level of direct support for the intervention lessened.ConclusionsThe paucity of initiatives in British Columbia and Ontario that address healthy eating and active living through action on the social determinants of health is problematic. In the context of Canada's increasingly neoliberal political and economic policy, the public health sector may face significant barriers to addressing upstream determinants in a meaningful way. If public health cannot directly affect broader societal conditions, interventions should be focused around advocacy and education about the social determinants of health. It is necessary that health be seen for what it is: a political matter. As such, the health sector needs to take a more political approach in finding solutions for health inequities.

Project description:BACKGROUND:Neuropathy and vasculopathy can lead to costly and debilitating complications in people with diabetes. The purpose of this study was to evaluate, at an organizational level, uptake of practices included in a diabetic foot care clinical pathway and associated resources. This research focused on patients at low and moderate risk in Alberta, Canada between 2014 to 2019. METHODS:Serial surveys (2014, 2019) of practices related to screening and care of the feet of people with diabetes. Surveys were administered using a combination of targeted and snowball sampling in order to assess the impact of the clinical pathway first implemented in 2015. The pathway focused on screening, assessment and referral of patients from primary care. High-risk foot teams (HRFT) were established at six sites to provide increased access to specialty care. Comparative statistics were performed to assess differences in footcare practices between 2014 and 2019 using two-tailed Fisher's exact test or Chi-square test. RESULTS:Respondents (n?=?104, 2014 and n?=?75, 2019) included personnel from primary health care, home care and long-term care, acute and emergency care, specialty clinics, diabetes-specific programs and private contractors. The proportion of primary care and home care/long-term care (HC/LTC) sites providing screening increased significantly (p?<?0.05). A significant increase in the proportion of sites providing assessment for patients designated as moderate risk also increased from 35% (34 out of 96 sites) to 55% (36 out of 65 sites) (p <?0.05), particularly with respect to vascular assessment, and the proportion of sites reporting appropriate follow-up intervals according to the pathway recommendation was also improved. CONCLUSION:Provision of a clinical pathway for diabetic foot care along with education and resources led to increased screening in primary care and HC/LTC settings in Alberta, Canada. HRFT provided primary healthcare providers with an important option for referral and also provided increased expertise for procedures such as vascular assessment for patients with moderate risk of ulceration. This comprehensive model has the potential to reduce progression of foot problems and overall health services utilization. Further analyses of outcomes such as incident lower limb amputation and long-term cost-effectiveness of pathway implementation are underway.

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Network analysis of inter-organizational relationships and policy use among active living organizations in Alberta, Canada.

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