Abstract
The Skin Cancer Prevention Team (SCPT) required a comprehensive approach for guiding its efforts in population-level skin cancer prevention. After identifying and reviewing several models, it concluded that an appropriate population-level model applicable to the Alberta context did not exist. Thus, the SCPT, under the Alberta Health Services — Cancer Prevention Program, developed and evaluated a model for Alberta. Three inclusion criteria for a comprehensive framework were identified: 1) use an ecological approach to population health; 2) function as a dynamic tool for planning, implementing and evaluating population-level efforts; and 3) address weaknesses in existing theory in population health and health promotion. Theoretical constructs were layered together, on the basis of the criteria, to develop an omnibus framework. The resulting Framework represents a layering of several constructs used in popular health promotion and population health theories. It merges principles of the realist approach to scientific enquiry with principles of ecological theory. The Framework outlines a three-step, dynamic process for planning, implementing and evaluating population-level efforts. It also provides insight into the larger, unifying influences for changes in health outcomes and the complex mechanisms of behaviour change processes at the population level.
Key words: Skin cancer, prevention, population health, health promotion, population health intervention, theory
Résumé
Notre équipe de prévention du cancer de la peau (ÉPCP) avait besoin d’une approche globale pour orienter ses efforts de prévention du cancer de la peau axés sur la population. Après avoir recensé et examiné plusieurs modèles, elle a conclu qu’il n’existait pas de modèle axé sur la population pouvant s’appliquer au contexte de l’Alberta. L’ÉPCP, dans le cadre du programme de prévention du cancer des Services de santé de l’Alberta, a donc mis au point et évalué un tel modèle. Nous avons cerné trois critères d’inclusion pour un cadre global. Celui-ci devait: 1) aborder la santé des populations selon une approche écologique; 2) fonctionner comme un outil dynamique de planification, de mise en œuvre et d’évaluation des efforts axés sur la population; et 3) tenir compte des faiblesses des théories actuelles en santé des populations et en promotion de la santé. Les construits théoriques ont été stratifiés, d’après ces critères, pour former un cadre composite. Le cadre résultant est une stratification de plusieurs construits utilisés dans les théories populaires en promotion de la santé et en santé des populations. Il fusionne les principes de l’approche réaliste de la science et les principes de la théorie écologique. Il définit un processus dynamique en trois étapes: planifier, mettre en œuvre et évaluer les efforts axés sur une population. Il donne aussi un aperçu des grands facteurs qui influencent globalement les changements dans les résultats sanitaires, ainsi que des mécanismes complexes des changements de comportement à l’échelle d’une population.
Mots clés: cancer de la peau, prévention, santé des populations, promotion de la santé, intervention en santé des populations, théorie
Footnotes
Acknowledgements: This report has been made possible through a financial contribution from the Canadian Partnership Against Cancer. We also acknowledge Corinne Parker, Lisa Petermann, Graham Petz and Silvana Lawvere for their hard work and support with this report.
Conflict of Interest: None to declare.
References
- 1.Alberta Cancer Board. Alberta Cancer Registry Report. 2006. [Google Scholar]
- 2.Krueger H, McLean D, Williams D. The prevention of secondary primary cancers. In: Bertino JR, editor. Progress in Experimental Tumor Research. Basel, Switzerland: S Karger AG; 2008. [Google Scholar]
- 3.Glanz K, Rimer BK, Lewis FM. Theory, research, and practice in health behaviour and health education. In: Glanz K, Rimer BK, Lewis FM, editors. Health Behaviour and Health Education: Theory, Research and Practice. 3rd ed. San Francisco, CA: Jossey-Bass; 2002. pp. 22–40. [Google Scholar]
- 4.Ferguson C, Vita P. A strategic framework for skin cancer prevention in NSW. New South Wales Public Health Bulletin. 2002;12(3):75–77. doi: 10.1071/NB01022. [DOI] [PubMed] [Google Scholar]
- 5.Montague M, Borland R, Sinclair C. Slip! slop! slap! SunSmart, 1980–2000: Skin cancer control and 20 years of population-based campaigning. Health Educ Behav. 2001;28(3):290–305. doi: 10.1177/109019810102800304. [DOI] [PubMed] [Google Scholar]
- 6.World Health Organization. Solar Ultraviolet Radiation: Global Burden of Disease from Solar Ultraviolet Radiation. Geneva, Switzerland: WHO; 2006. [Google Scholar]
- 7.Saraiya M, Glanz K, Briss PA, Nichols P, White C, Das D, et al. Interventions to prevent skin cancer by reducing exposure to ultraviolet radiation: A systematic review. Am J Prev Med. 2004;27(5):308–16. doi: 10.1016/j.ypmed.2004.04.022. [DOI] [PubMed] [Google Scholar]
- 8.Merzel C, D’Afflitti J. Reconsidering community-based health promotion: Promise, performance, and potential. Am J Public Health. 2003;93(4):557–74. doi: 10.2105/AJPH.93.4.557. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Green LW, Kreuter MW. Health Promotion Planning: An Educational and Environmental Approach. Mountain View, CA: Mayfield Publishing Company; 1991. [Google Scholar]
- 10.Health Canada. The Population Health Template: Key Elements and Actions That Define a Population Health Approach. Ottawa, ON: Health Canada; 2001. [Google Scholar]
- 11.McLaren L, Hawe P. Ecological perspectives in health research. J Epidemiol Community Health. 2008;59:6–14. doi: 10.1136/jech.2003.018044. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Thompson B, Kinne S. Social change theory: Applications to community health. In: Bracht NF, editor. Health Promotion at the Community Level. 2nd ed. University of Minnesota, Twin Cities, MN: SAGE Publications, Inc.; 1999. [Google Scholar]
- 13.Gatrell AC. Complexity theory and geographies of health: A critical assessment. Soc Sci Med. 2004;60(12):2661–71. doi: 10.1016/j.socscimed.2004.11.002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Hamilton N, Bhatti T. Population Health Promotion: An Integrated Model of Population Health and Health Promotion. Ottawa, ON: Health Promotion Development Division, Public Health Agency of Canada; 1996. [Google Scholar]
- 15.Prochaska JO, DiClemente CC. Toward a comprehensive model of change. In: Miller W H N, editor. Treating Addictive Behaviors: Processes of Change. 2nd ed. New York, NY: Plenum Press; 1998. pp. 3–27. [Google Scholar]
- 16.Hillhouse JJ, Adler CM, Drinnon J, Turrisi R. Application of Azjen’s theory of planned behavior to predict sunbathing, tanning salon use, and sunscreen use intentions and behaviors. J Behav Med. 1997;20(4):365–78. doi: 10.1023/A:1025517130513. [DOI] [PubMed] [Google Scholar]
- 17.Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall; 1986. [Google Scholar]
- 18.Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist Synthesis: An Introduction. Manchester, UK: University of Manchester; 2004. [Google Scholar]
- 19.National Institutes of Health. Theory At a Glance: A Guide For Health Promotion Practice. US: National Institutes of Health; 2005. [Google Scholar]
- 20.Chronic Disease Prevention Alliance of Canada. Knowledge Exchange in Health Promotion: Theoretical Models and Examples. Ottawa ON: Public Health Agency of Canada; 2007. [Google Scholar]
- 21.Alberta Cancer Board, Tobacco Control Unit. Snapshot of Tobacco Facts: A Resource Guide to Tobacco Control Planning in Alberta. Calgary, AB: Alberta Cancer Board; 2007. [Google Scholar]
- 22.Thurston WE, Potvin L. Evaluability assessment: A tool for incorporating evaluation in social change programs. Evaluation. 2003;9(4):453–69. doi: 10.1177/1356389003094006. [DOI] [Google Scholar]
- 23.Glasgow RE, McKay HG, Piette JD, Reynolds KD. The RE-AIM framework for evaluating interventions: What can it tell us about approaches to chronic illness management? Patient Educ Couns. 2001;44:119–27. doi: 10.1016/S0738-3991(00)00186-5. [DOI] [PubMed] [Google Scholar]
- 24.Rossi PH, Lipsey MW, Freeman HE. Evaluation: A Systematic Approach. 7th ed. Thousand Oaks, CA: Sage Publications Inc.; 2004. [Google Scholar]