Case 3: Campobello Island health and well-being needs assessment (2008-2009)

Verlé Harrop, PhD
Province of New Brunswick,
Research Mentor, UNB Faculty of Education

Introduction

In 2008, St. Joseph's Community Health Centre (CHC), in Saint John, New Brunswick, partnered with the residents of Campobello Island (population 1,056, Census 2006) to carry out a collaborative, community-based health and well-being needs assessment (NA). The purpose of this assessment was to establish a determinants of health baseline and action plan. Little was known about the island's needs aside from those related to its unique geographic location. During the summer months, a privately owned ferry operates between Campobello Island and Deer Island, but during the winter, islanders must cross the bridge into Lubec, Maine and drive 84 kilometers before re-entering Canada, a round trip requires passing through customs four times. The island's isolation, compounded by heightened post 9/11 border security and a perceived escalation in the local drug trade, signaled a community in crisis. In response, the CHC invited the Regional Health Authority's (RHA) Senior Researcher in Applied Health Research to perform a NA.

Methods

The research team carried out a four-phase program of Participatory Action Research. Qualitative data from interviews and focus groups underscored well-being challenges, while survey data quantified the pervasiveness of emergent themes. The research, production of the report, and formation of the action plans were all structured around the Public Health Agency of Canada's (PHAC) "12 Determinants of Health Framework."¹

Preliminary activities

In February 2008, the CHC issued an open invitation to the community to attend an "Informational Session" where Dr. Harrop presented the "Bell Island Health and Well-Being Needs Assessment, Phase 1, 2006."² Forty-eight people attended. In March 2008, the CHC hosted a follow-up public meeting and facilitated the election of the Campobello Island Health and Wellness Advisory Committee (AC), which represents seniors, single moms, persons on social assistance, teachers, nurses, and business. There were 45 participants at this event. An agreement in principle was struck between the AC and the CHC to collaborate on the NA, and the AC and researchers started meeting bi-weekly.

Phase I: Interviews and focus groups (May 10–15, 2008)

The NA team held six days of key informant interviews and focus groups. Over 270 islanders and health professionals participated in 56 sessions. The AC took complete responsibility for developing a representative invitee list and scheduling the sessions using Google Calendar and Facebook.

Phase II: Survey (June 18–20, 2008)

An eight-page survey structured around the "Determinants of Health" framework was developed by the NA team and deployed by the AC. Of approximately 650 eligible residents (aged 19+), 483 (74.3%) completed the survey. Over the summer, AC members reported a growing number of inquiries from Islanders about the "All About Us" survey findings.³

Phase III: "Building bridges — Building teams" (September 11–18, 2008)

Community- and systems-level interest in the survey findings was leveraged into a week of events structured around key concerns. At each event cited in Table 1, pertinent survey data were presented and augmented with the community's narrative. Representatives from the following organizations and communities then participated on panels and in facilitated question and answer periods: social development, addictions and mental health; Canada Mortgage and Housing Corporation; alternative and co-op housing; the RCMP; the school district; public health; the New Brunswick Extra-Mural Program; and experts in rural governance, community schools, teen centres, community access centres and on-line adult education. These events enabled islanders to personally identify and connect with the representatives from government and non-profit agencies who would be best able to collaborate with the community on local solutions.

All week, the research team connected and networked islanders, professionals and experts into intersectoral "communities of interest." The week concluded with special interest groups coming together and developing action plans, which they then shared with the community as a whole. Approximately 585 islanders, professionals and domain experts participated.

Phase IV: Action plans & interventions — "Where the Rubber Meets the Road" (October 2, 2008)

Recognizing the community's limited capacity and the identification of self-governance as the top priority, the 52 islanders formed nine working groups that continued to meet independently. Each working group gave an update on its work at monthly meetings held by the AC. The working groups' accomplishments are presented in Table 2.

Outcomes and impact

The NA process was foundational to Campobello Island becoming a self-governing Rural Community. Concerns around drugs faded as the community became more engaged with children and youth, and as community leaders came forward, health centre staff became more excited about their work and initiated outreach activities.

Lessons learned

To better support transparency, accountability, and ultimately sustainability, training around bookkeeping and formal civic and administrative protocols should have been incorporated onto the NA process.

Despite that, structuring the NA around PHAC's Determinants Framework:

• enabled citizens and agencies to understand the determinants and their interrelatedness;
• shifted expectations away from the health system and back to the community;
• created a gradient of entry points leading to action;
• enabled the community to identify, collect and leverage meaningful, comparative local data; and
• made the need for intersectoral cooperation and collaboration clear.

Finally, the NA process is incomplete without "knowledge translation," the grass roots process that is undergone by the whole community.

Date modified:

2013-11-19