Abstract
OBJECTIVES: To assess potential inequitable impacts of a proposed Teen Triple P Positive Parenting Program (Teen PPP) in Manitoba to achieve equity of access and outcomes for families of diverse backgrounds; recommend (if required) alternative actions to promote greater equity of access and outcomes for families participating in Teen PPP; and evaluate the influence of recommendations on implementation of the proposed program.
INTERVENTION: An equity-focused health impact assessment (EfHIA) of the proposed Teen PPP was conducted, using a standard EfHIA framework. Methods used to assess potential Teen PPP impacts included: a literature review, key informant interviews and 14 community consultations. Evidence was analyzed, summarized and presented to the project Steering Committee (SC), along with draft recommendations for ensuring that equity is considered in Teen PPP planning and rollout.
OUTCOMES: The SC prioritized 12 possible inequitable impacts of Teen PPP with potential to prevent certain parents/caregivers either from accessing the proposed program or benefitting adequately from the program, causing them to drop out prematurely. Recommendations for avoiding these impacts were finalized by the SC and presented to provincial government officials responsible for the proposed program. Follow-up interviews with these individuals indicated that the recommendations were well received and raised equity-related issues that will be considered in future program planning decisions.
CONCLUSION: EfHIA is a proven planning tool for ensuring that health equity is considered in all policies, which is one of the necessary conditions for reducing inequities and closing the health equity gap throughout Canada within a generation.
Key Words: Health impact assessment, health status disparities, vulnerable populations, parenting education
Résumé
OBJECTIFS: Évaluer les effets potentiellement inéquitables d’un projet de programme de pratiques parentales positives (Triple P) pour les parents d’adolescents au Manitoba afin d’offrir un accès et des résultats équitables aux familles de divers milieux; de recommander (au besoin) des mesures de rechange pour promouvoir plus d’équité dans l’accès et les résultats des familles participant à Teen Triple P; et d’évaluer l’influence des recommandations sur la mise en oeuvre du programme proposé.
INTERVENTION: Nous avons mené une évaluation d’impact sur la santé axée sur l’équité (ÉISAÉ) du programme Teen Triple P proposé, à l’aide d’un cadre d’ÉISAÉ type. Les méthodes suivantes ont servi à évaluer les effets potentiels de Teen Triple P: une revue de la littérature spécialisée, des entretiens avec des informateurs et 14 consultations communautaires. Les données probantes ont été analysées, résumées et présentées au comité directeur (CD) du projet, accompagnées de recommandations préliminaires pour que l’équité soit prise en compte dans la planification et le déploiement de Teen Triple P.
RÉSULTATS: Le CD a priorisé 12 effets inéquitables possibles de Teen Triple P qui risqueraient d’empêcher certains parents ou aidants d’accéder au programme proposé ou d’en bénéficier convenablement, ce qui les ferait abandonner prématurément le programme. Les recommandations pour éviter ces effets ont été parachevées par le CD et présentées aux fonctionnaires provinciaux responsables du programme proposé. Des entretiens de suivi auprès de ces personnes ont indiqué que les recommandations ont été bien accueillies et qu’elles ont soulevé des questions d’équité qui seront prises en compte dans les futures décisions de planification du programme.
CONCLUSION: L’ÉISAÉ est un outil de planification éprouvé pour que l’équité en santé soit prise en compte dans toutes les politiques, ce qui est l’une des conditions nécessaires pour réduire les iniquités et combler le fossé de l’équité en santé partout au Canada en une génération.
Mots Clés: évaluation d’impact sur la santé, disparités d’état sanitaire, populations vulnérables, information aux parents
Footnotes
Conflict of Interest: None to declare.
References
- 1.World Health Organization. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health: Final Report of the Commission of Social Determinants of Health. Geneva: WHO; 2008. [DOI] [PubMed] [Google Scholar]
- 2.Sanders MR, Markie-Dodds C, Turner KM. Theoretical, scientific and clinical foundations of the Triple P-Positive Parenting Program: A population approach to the promotion of parenting competence. Parenting Pract Monogr. 2003;1:1–21. [Google Scholar]
- 3.Sanders M. Development, evaluation and multi-national dissemination of the Triple P-positive parenting program. Annu Rev Clin Psychol. 2012;8:345–79. doi: 10.1146/annurev-clinpsy-032511-143104. [DOI] [PubMed] [Google Scholar]
- 4.Morawska A, Sanders MR, Goadby E, Headley C, Hodge L, McAuliffe C, et al. Is the Triple P-Positive Parenting Program acceptable to parents from culturally diverse backgrounds? J Child Family Stud. 2012;20:614–22. doi: 10.1007/s10826-010-9436-x. [DOI] [Google Scholar]
- 5.Houlding C, Schmidt F, Stern SB, Jamieson J, Borg D. The perceived impact and acceptability of Group Triple P Positive Parenting Program for Aboriginal parents in Canada. Child Youth Serv Rev. 2012;34:2287–94. doi: 10.1016/j.childyouth.2012.08.001. [DOI] [Google Scholar]
- 6.Turner KMT, Richards M, Sanders MR. A randomized clinical trial of a group parent education programme for Australian indigenous families. J Paediatr Child Health. 2010;43:429–37. doi: 10.1111/j.1440-1754.2007.01053.x. [DOI] [PubMed] [Google Scholar]
- 7.Wilson P, Rush R, Hussey S, Puckering C, Sim F, Allely CS, et al. How evidence-based is an ‘evidence-based parenting program’? A PRISMA systematic review and meta-analysis of Triple P. BMC Med. 2012;10:130. doi: 10.1186/1741-7015-10-130. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Turner K, Sanders M. Family intervention in indigenous communities: Emergent issues in conducting outcome research. Australas Psychiatry. 2007;15(Suppl1):S39–43. doi: 10.1080/10398560701701189. [DOI] [PubMed] [Google Scholar]
- 9.Turner MT, Richards M, Sanders MR. Randomised clinical trial of a group parent education programme for Australian Indigenous families. J Paediatr Child Health. 2007;43:429–37. doi: 10.1111/j.1440-1754.2007.01053.x. [DOI] [PubMed] [Google Scholar]
- 10.Ralph A, Sanders MR. Preliminary evaluation of the group teen triple P program for parents of teenagers making the transition to high school. Aust J Adv Ment Health. 2003;2:169–78. doi: 10.5172/jamh.2.3.169. [DOI] [Google Scholar]
- 11.Ralph A, Sanders MR. The ‘Teen Triple P’ positive parenting program: A preliminary evaluation. Trends Issues Crime Crim Justice. 2004;282:1–6. [Google Scholar]
- 12.Ralph A, Toumbourou JW, Grigg M, Mulcahy R, Carr-Gregg M, Sanders MR. Early intervention to help parents manage behavioural and emotional problems in early adolescents: What parents want. Aust J Adv Ment Health. 2003;2:156–68. doi: 10.5172/jamh.2.3.156. [DOI] [Google Scholar]
- 13.Capewell S, Graham H. Will cardiovascular disease prevention widen health inequalities? PLoS Med. 2010;7(8):e1000320. doi: 10.1371/journal.pmed.1000320. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Frohlich K, Potvin L. Transcending the known in public health practice. The inequality paradox: The population approach and vulnerable populations. Am J Public Health. 2008;98(2):216–21. doi: 10.2105/AJPH.2007.114777. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Rice W. Health Promotion Through an Equity Lens: Approaches, Problems and Solutions. Toronto, ON: Wellesley Institute; 2010. [Google Scholar]
- 16.Whittaker K, Cowley S. An effective programme is not enough: A review of factors associated with poor attendance and engagement with parenting support programmes. Child Soc. 2012;26(2):138–49. doi: 10.1111/j.1099-0860.2010.00333.x. [DOI] [Google Scholar]
- 17.Koerting J, Smith E, Knowles MM, Latter S, Elsey H, McCann DC, et al. Barriers to, and facilitators of, parenting programmes for childhood behaviour problems: A qualitative synthesis of studies of parents’ and professionals’ perceptions. Eur Child Adolesc Psychiatry. 2013;22:653–70. doi: 10.1007/s00787-013-0401-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Healthy Child Manitoba. Triple P–The Positive Parenting Program: A Developmental Evaluation of Manitoba’s Provincial Implementation. Winnipeg, MB: Healthy Child Manitoba; 2010. [Google Scholar]
- 19.Martens PJ, Brownell M, Au W, MacWilliam L, Prior H, Schultz J, et al. Health Inequities in Manitoba: Is the Socioeconomic Gap Widening or Narrowing Over Time? Winnipeg, MB: Manitoba Centre for Health Policy; 2010. [Google Scholar]
- 20.Brownell M, Chartier M, Santos R, Ekuma O, Au W, Sarkar J, et al. How are Manitoba’s Children Doing? Winnipeg, MB: Manitoba Centre for Health Policy; 2012. [Google Scholar]
- 21.Ravens-Sieberer U, Torsheim T, Hetland J, Vollebergh W, Cavallo F, Jericek H, et al. HBSC Positive Health Focus Group. Subjective health, symptom load and quality of life of children and adolescents in Europe. Int J Public Health. 2009;54:S151–59. doi: 10.1007/s00038-009-5406-8. [DOI] [PubMed] [Google Scholar]
- 22.Loppie R C, Wien F. Health Inequalities and Social Determinants of Aboriginal Peoples’ Health. Prince George, BC: National Collaborating Centre for Aboriginal Health; 2009. [Google Scholar]
- 23.TruthReconciliation Commission of Canada [TRCC]. Honouring the Truth, Reconciling for the Future: Summary of the Final Report. Ottawa, ON: TRCC; 2015. [Google Scholar]
- 24.European Centre for Health Policy. Health Impact Assessment: Main Concepts and Suggested Approach. Gothenburg Consensus Paper. Brussels: WHO Regional Office for Europe; 1999. [Google Scholar]
- 25.Harris-Roxas B, Simpson JS, Harris E. Equity Focused Health Impact Assessment: A Literature Review. Sydney: University of New South Wales, Centre for Health, Equity, Training, Research and Evaluation; 2004. [Google Scholar]
- 26.Povall S, Haigh F, Abrahams D, Scott-Samuel A. Health equity impact assessment. Health Promot Int. 2014;29(4):621–33. doi: 10.1093/heapro/dat012. [DOI] [PubMed] [Google Scholar]
- 27.Mahoney M, Simpson S, Harris E, Aldrich R, Stewart W J. Equity-Focused Health Impact Assessment Framework. Newcastle: Australasian Collaboration for Health Equity Impact Assessment; 2004. [Google Scholar]
- 28.Iroz-Elardo N. Health impact assessment as community participation. Comm Devel J. 2014;50(2):280–85. doi: 10.1093/cdj/bsu052. [DOI] [Google Scholar]
- 29.Health Development Agency [HAD]. A Retrospective Process Evaluation of Five HIAs. London: HAD; 2004. [Google Scholar]