This paper was presented as a technical background paper at the WHO sixth Global Conference on Health Promotion in Bangkok Thailand, August 2005. It describes what we know about the effectiveness of four of the Ottawa Charter health promotion strategies from eight reviews that have been conducted since 1999. The six lessons are that (i) the investment in building healthy public policy is a key strategy; (ii) supportive environments need to be created at the individual, social and structural levels; (iii) the effectiveness of strengthening community action is unclear and more research and evidence is required; (iv) personal skills development must be combined with other strategies to be effective; (v) interventions employing multiple strategies and actions at multiple levels are most effective; (vi) certain actions are central to effectiveness, such as intersectoral action and interorganizational partnerships at all levels, community engagement and participation in planning and decision-making, creating healthy settings (particularly focusing on schools, communities, workplaces and municipalities), political commitment, funding and infrastructure and awareness of the socio-environmental context. In addition, four case studies at the international, national, regional and local levels are described as illustrations of combinations of the key points described earlier. The paper concludes that the four Ottawa Charter strategies have been effective in addressing many of the issues faced in the late 20th century and that these strategies have relevance for the 21st century if they are integrated with one another and with the other actions described in this paper.

Single crystals of KOH-doped ice Ih, transformed into the low-temperature ordered phase known as ice XI, have been studied by neutron diffraction. High-resolution measurements show a splitting of the 00l diffraction peaks into an ice XI and a residual ice Ih component, with about 37% transformation to ice XI. New diffraction peaks from the ice XI have been measured. These are consistent with a ferroelectrically ordered structure with space group Cmc2 1 .

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Often the goal of health and social development agencies is to assess communities and work with them to improve community capacity. Particularly for health promoters working in community settings and to ensure consistency in the definition of health promotion, the evaluation of health promotion programmes should be based on strengths and assets, yet existing information for planning and evaluation purposes usually focuses on problems and deficits. A model and definition of community capacity, grounded in community experience and focusing on strengths and assets, was developed following a 4-year, multi-site, qualitative, action research project in four Toronto neighbourhoods. There was significant community involvement in the four Community Advisory Committees, one for each study site. Semi-structured, open-ended interviews and focus groups were conducted with 161 residents and agency workers identified by the Community Advisory Committees. The data were analyzed with the assistance of NUDIST software. Thematic analysis was undertaken in two stages: (i) within each site and (ii) across sites, with the latter serving as the basis for the development of indicators of community capacity. This paper presents a summary of the research, the model and the proposed indicators. The model locates talents and skills of community members in a larger context of socioenvironmental conditions, both inside and outside the community, which can act to enable or constrain the expression of these talents and skills. The significance of the indicators of community capacity proposed in the study is that they focus on identifying and measuring the facilitating and constraining socioenvironmental conditions.

BackgroundThe present study’s aim has been to investigate, identify and interpret the views of pediatric primary healthcare providers on the recognition and management of maternal depression in the context of a weak primary healthcare system.MethodsTwenty six pediatricians and health visitors were selected by using purposive sampling. Face to face in-depth interviews of approximately 45 minutes duration were conducted. The data were analyzed by using the framework analysis approach which includes five main steps: familiarization, identifying a thematic framework, indexing, charting, mapping and interpretation.ResultsFear of stigmatization came across as a key barrier for detection and management of maternal depression. Pediatric primary health care providers linked their hesitation to start a conversation about depression with stigma. They highlighted that mothers were not receptive to discussing depression and accepting a referral. It was also revealed that the fragmented primary health care system and the lack of collaboration between health and mental health services have resulted in an unfavorable situation towards maternal mental health.ConclusionsEven though pediatricians and health visitors are aware about maternal depression and the importance of maternal mental health, however they fail to implement detection and management practices successfully. The inefficiently decentralized psychiatric services but also stigmatization and misconceptions about maternal depression have impeded the integration of maternal mental health into primary care and prevent pediatric primary health care providers from implementing detection and management practices.

BackgroundIn Haiti, the number of women dying in pregnancy, during childbirth and the weeks after giving birth remains unacceptably high. The objective of this research was to explore determinants of maternal mortality in rural Haiti through Community-Based Action Research (CBAR), guided by the delays that lead to maternal death. This paper focuses on socioecological determinants of maternal mortality from the perspectives of women of near-miss maternal experiences and community members, and their solutions to reduce maternal mortality in their community.MethodsThe study draws on five semi-structured Individual Interviews with women survivors of near-misses, and on four Focus Group Discussions with Community Leaders and with Traditional Birth Attendants. Data collection took place in July 2013. A Community Research Team within a resource-limited rural community in Haiti undertook the research. The methods and analysis process were guided by participatory research and CBAR.ResultsParticipants identified three delays that lead to maternal death but also described a fourth delay with respect to community responsibility for maternal mortality. They included women being carried from the community to a healthcare facility as a special example of the fourth delay. Women survivors of near-miss maternal experiences and community leaders suggested solutions to reduce maternal death that centered on prevention and community infrastructure. Most of the strategies for action were related to the fourth delay and include: community mobilization by way of the formation of Neighbourhood Maternal Health/Well-being Committees, and community support through the provision/sharing of food for undernourished women, offering monetary support and establishment of a communication relay/transport system in times of crisis.ConclusionsFinding sustainable ways to reduce maternal mortality requires a community-based/centred and community-driven comprehensive approach to maternal health/well-being. This includes engagement of community members that is dependent upon community knowledge, political will, mobilization, accountability and empowerment. An engaged/empowered community is one that is well placed to find ways that work in their community to reduce the fourth delay and in turn, maternal death. Potentially, community ownership of challenges and solutions can lead to more sustainable improvements in maternal health/well-being in Haiti.

Different sets of competencies in public health, global health and research have recently emerged, including the Core Competencies for Public Health in Canada (CCPHC). Within this context, we believe it is important to articulate competencies for global health practitioners-educators and researchers that are in addition to those outlined in the CCPHC. In global health, we require knowledge and skills regarding: north-south power dynamics, linkages between local and global health problems, and the roles of international organizations. We must be able to work responsibly in low-resource settings, foster self-determination in a world rife with power differentials, and engage in dialogue with stakeholders globally. Skills in cross-cultural communication and the ability to critically self-reflect on one's own social location within the global context are essential. Those in global health must be committed to improving health equity through global systems changes and be willing to be mentored and to mentor others across borders. We call for dialogue on these competencies and for development of ways to assess both their demonstration in academic settings and their performance in global health practice and research.

In attempting to use a realistic evaluation approach to explore the role of Community Parents in early parenting programs in Toronto, a novel technique was developed to analyze the links between contexts (C), mechanisms (M) and outcomes (O) directly from experienced practitioner interviews. Rather than coding the interviews into themes in terms of context, intervention elements (mechanisms) and outcomes separately and which could be assembled into CMO configurations by the analyst, they were coded as linked dyads and triads directly from the practitioner narratives. Out of all of the linked codes entered, there were a maximum of three with the same combination, presenting challenges for typical qualitative data analysis. This article examines a novel technique that was developed in an attempt to expand this method beyond the circumstances described in the realistic evaluation literature to date. The bulk of the article focuses on the linked coding and analysis procedures, the challenges faced, and the original solutions that were developed to analyze the CMO relations and generate the mid-range theories necessary to move to the next stage of a realist evaluation approach. The features that distinguish this linked coding method from other methods (e.g. Qualitative Comparative Analysis), the major benefits and drawbacks, the utility of the approach within evaluation practice, and its application to realist synthesis and research are discussed. Downloaded from and published evidence, the literature typically describes a qualitative interview process with the plausible hypotheses derived logically from the data. Pawson and Tilley describe an interactive interview or dialogue as a method to understand context, mechanism, and outcome relations where the interviewer and the interviewee co-develop these hypotheses (Pawson & Tilley, 1997). If many practitioners are involved, is there another way that these relations can be uncovered using interviews with a group of practitioners?Several methodological problems are posed in trying to do this. One is the need to ask the right questions to collect information about the contexts, and the program activities and characteristics that could become mechanisms. A second is how to recognize the CMO connections that are made implicitly or explicitly in the data. A third major problem is how to analyze connected strings of data in a way that is different from grouping codes under common themes. This article will examine a novel technique that was developed in an attempt to expand this method beyond the circumstances described in the realistic evaluation literature to date. We begin by examining the realist evaluation literature related to coding, and then describe the case and data collection methods. The bulk of the article focuses on the analysis methods, the challenges we faced, and the solutions that were developed. We end by describing the strengths and limitations of the linked coding approach and suggest implications for evaluation practice and future research.