Community Development Approaches to Heart Health Promotion: A Geographical Perspective
This paper reports results of a qualitative study of community development approaches to heart health promotion in Ontario. Cardiovascular disease (CVD) represents a substantial proportion of the burden of illness experienced by western industrialized countries. Biomedical research has implicated lifestyle choices and socioeconomic conditions as primary determinants of CVD. There has been a resultant shift from curative to preventive/health promoting strategies to reduce this burden of illness. The Canadian Heart Health Initiative-Ontario Project (CHHIOP), a two-stage (quantitative and qualitative) longitudinal study, was designed to address issues of heart health promotion through the investigation and strengthening of community-based heart health activities in both the formal and informal public health systems. The study reported on in this paper forms one part of the qualitative stage and focuses on how community relationships and community development approaches play out in local contexts to shape the reality of (heart) health promotion practice. Analysis of key informant interviews using Ethnograph illustrates the centrality of community context, the lack of a common understanding of key concepts (e.g., community development), and the emergence of a shift in health agencies' ways of doing business characterized by increased partnering and collaboration in the delivery of (heart) health promotion programs. Local perspectives and the dynamics of intra-community relations were allowed to emerge through the use of qualitative approaches implying a need for place-sensitive (heart) health promotion strategies.