1. CPHA 2008 Public health messaging and program delivery: an ethical approach Heidi Piovoso Suzanne Galesloot

2. Context Calgary Health Region  Focus Area: Healthy Growth and Obesity Prevention  Strategy Area Public Health messaging and programming, “Healthy Feeding Relationship” CPHA 2008

3. The Challenge R E A C H = middle-to-upper income and higher-educated families CPHA 2008

4. The Opportunity An existing partnership with: Agencies servicing families who experience “health disparities”  PATCH, The Alex Health promotion and disease prevention divisions of health organizations  Calgary Health Region, Alberta Cancer Board  Interest in exploring approaches to bring Health Promotion & Disease Prevention to client groups/agencies CPHA 2008

5. Evidence Limited published research  Appropriate content and format for applying feeding relationship  Strategies to support target population Local assessments  Agency consultations  Diversity liaisons  Focus groups with families PATCH, Chinook Health Region  Email list-serves CPHA 2008

6. Project Purpose To develop, pilot test and evaluate a workshop format for delivering healthy feeding relationship messages to lower-income and culturally-diverse groups. CPHA 2008

7. Program Development Adapted content and delivery of healthy feeding relationship workshop First Pilot (3 agencies)  addition of childcare and food Second Pilot (6 agencies)  targeted planning with agency staff  established parenting groups  agency staff required at sessions  provision as needed: childcare, transportation, translation CPHA 2008

8. Content Adaptations Specific attention/sensitivity to issues that may complicate messages  Lower household income  Inconsistent practices  Personal experiences  Social and/or emotional history  Cultural and familial norms, values and parenting experiences CPHA 2008

9. Content Adaptations (Continued) Be sensitive to barriers families may face in implementing messages. Focus first on what CAN be done, within financial and other restraints. Some examples:  Caregivers who cannot provide healthy food choices regularly can have an influence on their child's healthy growth.  Assumptions cannot be made about a family’s cultural values, beliefs and norms. CPHA 2008

10. Approach Adaptations Communicating key messages  Facilitated, learner-centered approach  Visual and Kinesthetic learning tools  Focus on one or two key points  Be flexible Establish relationships with agencies who have established parent/caregiver groups  Agency/staff involvement prior to and during the sessions Facilitate access  Childcare, transportation, food, translation CPHA 2008

11. Key Findings for Practice Program Planning Existing partnerships are critical in assessing “stage of readiness” of target group for key public health messaging. Research is essential in determining appropriate content and strategies. Need to critically examine public health messaging for unintentional bias towards higher SES, non-immigrant populations. CPHA 2008

12. Key Findings for Practice Program Development/Implementation Relationship building and establishing RAPPORT are critical. Strong FACILITATION skills; training in learner- centered approach. Provision of on-site solutions to increase access to program participation. CPHA 2008

13. Key Findings for Practice Program Observation/Conclusions Process (described) worked for us in developing public health nutrition programming for lower- income and culturally-diverse families The gap is not a lack of effective programs in public health, rather content and delivery approaches sensitive to the barriers facing diverse populations. Long-term public health funding to support relationship building and skilled program delivery is necessary. CPHA 2008

15. Contacts Heidi Piovoso, Nutrition Specialist Heidi.piovoso@calgaryhealthregion.ca 403-943-8109 Suzanne Galesloot, Nutrition Specialist Suzanne.galesloot@calgaryhealthregion.ca 403-943-8126 CPHA 2008