Last spring, the Réseau des centres ontariens de ressources pour la promotion de la santé (Réseau CORPS) (Ontario Health Promotion Resource System) held discussion groups across the province. For those who aren't familiar with Réseau CORPS, it is a coordinated system of 22 resource centres dedicated to providing health promoters with effective support. The resource centres that are part of Réseau Corps are funded by the Health Promotion and Wellness sector of the Public Health Branch of the Ontario Ministry of Health and Long-Term Care. Réseau CORPS has a French- language services committee with a mandate to support the planning and development of French-language services and resources.
The discussion groups took place in Sudbury, Ottawa, and Toronto. Their goal was to stimulate reflection on the concept of health promotion and to compile participants' comments, suggestions, and experiences in this field. Participants included youth and a range of representatives from government, mental health, community-based, and university sectors. Through these discussions, the Réseau was able to collect qualitative data from health promoters who work in agencies other than health units and community health centres.
The objectives of the discussion groups were
* to explore and understand the various perspectives of health promoters, other than those working in public health units and community health centres, concerning the concept of health promotion;
* to identify and gain a better understanding of the obstacles and challenges facing health promoters, other than those working in public health units and community health centres, in a minority francophone environment;
* to evaluate the degree of familiarity with the services and support offered by Réseau CORPS and its resource centres; and
* to collect accounts of work experience in the field of health promotion.
II Discussion Group Highlights
We asked participants for their definitions of health promotion. Many of them responded by using a variety of terms to explain their health promotion activities. Readers should note that most respondents were not working directly in health care institutions and are not especially familiar with the terminology used in this field. The main purpose of the language used was to describe their health promotion activities. We realized that it was important to establish a common language and to clarify the terms of reference so as to establish a shared understanding of the concept of health promotion and its essential strategies among health promoters. The participants also discussed the changing concept of health promotion over the past 15 years, including the fact that health promotion no longer boils down to the absence of illness and that nowadays it is an approach that takes into consideration a host of factors that have a positive or negative effect on the state of health of an individual or a population: health determinants. They agreed that governments do not always understand this holistic approach and that some areas of health promotion are still not as successfully integrated as others because they have not achieved as much recognition in the health care system.
We also asked the participants if they were familiar with Réseau CORPS. Most of them said they knew nothing about it. A few did because they had attended a presentation on Réseau CORPS during Ontario Health Promotion Summer School 2003. A number of participants were interested in learning more about its history and mandate, the resources and services it offers, and its member organizations. They found its structure interesting but wondered how advantageous it would be for them, as health promoters, to combine all these organizations in a single network. They also commented that combining them probably gave members certain advantages: "maximizing funding," "a central source of information to help health promoters find the resources and services they're looking for," and "providing a health promotion Web portal."
We also asked the participants what they thought was the best way to promote Réseau CORPS. They suggested using the existing Web site (http://www.ohprs.ca/index_f.html) and enriching its content (brief descriptions of the mandate and services of each resource centre, the Réseau's mandate, target group(s), what each one has to offer in practical terms). They mentioned the advantages of promoting the Réseau at health care-related events (such as forums, symposiums, conferences, and training sessions) and buying advertising space in health care journals. Another suggestion was to create a directory of services, publication,s and other resources offered by the resource centres.
The next question concerned the resource centres that are members of Réseau CORPS. Very few participants were familiar with all of the resource centres. They knew about some because they were associated with their areas of intervention. They mentioned that when they looked at the list of resource centres without any description of each one's mandate and services, it could be confusing. A number of participants commented that there were a lot of resource centres that dealt with drug abuse and smoking and they wondered how they were related. The list of resource centres could give the impression of a duplication of services. Some participants could see the advantages of uniting health promotion resource centres but they wondered what the criteria for Réseau CORPS membership had been. The suggestion was made to "expand" membership in the Réseau to include other agencies offering services and resources in other fields such as AIDS and violence prevention.
The best-known resource centres are the Program Training and Consultation Centre, Ontario Prevention Clearinghouse, Ontario Healthy Communities Coalition, FOCUS, Council on Drug Abuse, and Alcohol Policy Network.
The participants' responses to the question, "What services or support would be useful in pursuing the development of your health promotion knowledge?" are a good illustration of the description of community development. They vary a great deal depending on the participants' areas of intervention, the skills they have acquired, the support they get from their organization and their network.
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III Promoting Réseau CORPS
In order for Réseau CORPS to continue to promote the skills development of its members, the participants suggested the following courses of action.
* Develop regional training activities to increase health promoters' effectiveness (knowledge) and ability (skills) through one- or two-day regional mini-conferences offering a number of training sessions on various topics. The mini-conferences would give francophone health promoters an opportunity to exchange information and expertise.
* Facilitate access to training materials in both languages, since the reality of the Franco-Ontarian situation is that although many health promoters' French is quite good, many of them received their education in English and are therefore more at ease with the English terminology. Many health promoters work in an anglophone environment and must share their resources with their anglophone colleagues or with anglophone managers.
* Diversify training delivery methods. According to participants, face-to-face is still the preferred training method but agencies cannot always afford to pay for their health promoters to attend or to be replaced during their absence. They suggested looking into other methods of training such as learning circles which take place on a regular basis by conference call.
* Make the most of Franco-Ontarian expertise by inviting francophone professionals and academics to deliver training. Many participants noted that francophone health promoters often attend English-language training activities because the guest speakers are well known in their field and this is not always the case for the francophone speakers.
* Share information on programs, resources, and expertise available in French Ontario. To achieve this, many participants suggested starting up a newsletter and a newsgroup. The suggestion was also made to hold a "Health Fair" where agencies offering health promotion activities could promote their services, identify issues they are dealing with, expand their network, and identify and form partnerships. Participants also recommended providing an electronic training schedule they could consult for information about training activities offered by the resource centres in the Réseau.
* Use the new technologies to distribute information, although some participants mentioned a need not to use these technologies only. Francophones still make abundant use of the time-honoured methods of communication. Some participants cited as examples delays in accessing some Web sites, the limitations of the equipment being used, and users' limited computer knowledge. For instance, not everyone realizes they can download Adobe Reader to get access to PDF documents. They generally use print documents. In spite of these limitations, many health promoters communicate with one another and share information by e-mail. They would like a newsgroup started up to facilitate this sharing of information.
* Francophone health promoters do not consider identifying French-language resources from outside Ontario the ideal solution, but it is a starting-point. The participants suggested having a clearinghouse for French-language health promotion resources, to be achieved by mapping the French-language health promotion resources and services available in Ontario (locally and regionally).
* The French-language translation and adaptation of documentation published in English was suggested. Although the participants noted they were cautious when using translations because they were not always satisfactory. The participants suggested striking a committee either to check the translation and adaptation of documentation published in English or to make recommendations.
* Establish a common language for health promotion to demystify the field and develop a shared understanding of the health promotion approach. The participants suggested a lexicon of the terminology used in health promotion, which could be posted on the Réseau's Web site.
* Illustrate the effectiveness and the positive impact of health promotion interventions by compiling "health promotion success stories" from a variety of non-health-related sectors and posting them on the Réseau's Web site.
* Disseminate the studies and surveys concerning health in Ontario's francophone community and illustrate their application in health promoters' everyday practice.
* Compile an inventory of available French-language health promotion resources.
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IV Factors in Successful Initiatives
During the discussion groups, we wanted to learn more about the participants' work in Ontario's francophone communities, so we asked the question, "In your work with francophones, what are the key factors that result in successful initiatives?"
The participants' discussions revealed certain factors that play a key role in the success of their projects and programs. Despite the diversity of the environments that were represented, there were many similar success factors for French-language initiatives. No single factor was responsible for success, but rather a combination:
* Responding to the community's needs - a project that responds to the community's needs and is practical, structured. and has a certain continuity can readily be implemented. Another success factor is involving the target group in the planning, implementation, and delivery of the activities to ensure that the activity or program responds effectively to its needs.
* Exchange of information and resources - knowing who does what and which resources are available in the community avoids the duplication of work that has already been done and makes the most of the work for more effective community-based intervention.
* Partnership - the involvement and contribution of all project stakeholders is essential. Building on cooperative partnership ensures that priorities and goals are jointly established, human and financial resources can be shared , and together a stronger message is conveyed to the target group.
* Networking - networking is essential because it facilitates the purposeful and strategic formation of connections that can open up new avenues and new perspectives.
* Visibility and credibility of the organization within the community - it is important to have visibility and credibility within the community to obtain the support of the local population, partners and government decision-makers.
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* Lack of French-language resources - the participants disagreed on this issue. Those working in larger organizations have access to more resources as such, but also to information networks which often extend outside the province. These resources, however, do not always reflect the Franco-Ontarian context. The health promoters often use them as working documents. They also noted the lack of visual resources for education and awareness purposes.
* Level of language used in resources - the level of language used in education and awareness materials can be a problem for the target clientele, which does not necessarily identify with the image or message being conveyed. In addition, there is a high rate of illiteracy in the Franco-Ontarian community so it is necessary to come up with simple, image-rich ways of conveying the message.
* Go beyond mere translation - the translation of resources is an approach that francophones, both health promoters and members of the community, do not encourage at all and that is readily recognizable. Instead, resources must be available that can reach the target clientele and speak their language and relate to their experience. Health promoters also have so-called "adapted" resources, which are a compromise. They often use them to develop their own resources which address the specific needs of the communities they serve (culturally adapted).
The small number of francophones in some communities, their geographic distribution, the low demand for French-language information and the lack of knowledge about effective francophone outreach methods are the key challenges facing health promoters.
* Communication - it has been shown that in a minority environment, word of mouth and social contact are still effective. In addition, many ethnocultural communities belong to the Franco-Ontarian community. Health promoters must culturally adapt their documentation and approaches to help the members of these communities feel included and take an active part in the programs and projects that are being offered.
* Rural vs. urban approaches - most of Ontario's rural communities are facing challenges concerning the delivery of health care. Out of necessity, rural regions have come up with efficient ways of delivering care. Health promoters in rural environments adopt an approach based on cooperative models that takes different social, geographic and economic characteristics into consideration. The advantages of this cooperative approach include the development of holistic intervention, improved communication, the efficient use of limited resources, and the reduction of duplication and gaps.
Recruitment and Retention of Health Promoters
* Workforce stability - many participants explained that a lack of financial resources frequently creates difficulties in human resources management. Organizations with better funding or recurrent funding programs experience much less turnover.
* Making the most of Franco-Ontarian expertise - many participants noted a failure to make the most of the knowledge and expertise of Franco-Ontarian health care professionals and the way that can affect participation in French-language training activities. One example cited was the Health Promotion Summer School, where many of the francophone speakers come from Quebec. Ontario has two colleges and two universities that offer a network of health care experts. Introducing these experts, their areas of expertise, and their research to health promoters would have a number of advantages. Making the most of this knowledge and expertise also involves its recognition.
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In conclusion, the discussion groups helped us gain a better understanding of the needs and challenges francophone health promoters must deal with in their work. We learned a great deal of lessons, which will be used to improve the planning of the direction and implementation of capacity-building activities for both individuals and organizations. The next step will be to continue guiding the development of French-language resources and services within the health promotion resource centres that are members of Réseau CORPS.
To learn more about Réseau CORPS, visit its Web site at http://www.ohprs.ca/index_f.html.