(PDF) Rural Community Health and Well-Being: A Guide to Action

Health

Population

Social

Supports

Community

Processes

R

ecreation

Heritage

Arts

Community

Infrastructure

Environment

Education

Economics

Safety

&

Security

Assets &

Strengths

Stressors

Health &

Well-Being

Community

Resiliency

Stressors

Community Action

(Becoming)

Interactions as a

collective unit

(Being)

Stressors

Expression of

a sense

of community

(Belonging)

Rural Community Health and Well-Being:

A Guide to Action

Edited by:

Robert Annis

Frances Racher

Marian Beattie

Rural Community Health and Well-Being:

A Guide to Action

Edited by:

Robert Annis, Frances Racher and Marian Beattie

Rural Development Institute

Brandon University

270 18th Street

Brandon, Manitoba, R7A 6A9

http://www.brandonu.ca/rdi

rdi@brandonu.ca

This project was sponsored by

Social Sciences and Humanities Research Council of Canada,

Grant 828-1999-1029, Strategic Theme: Society, Culture and Health of Canadians

CANADA R7A 6A9

utilized in any form or by any electronic, mechanical, or other means, now known or hereafter

invented, including photocopying and recording, or in any information storage or retrieval

systems, without the written permission from the authors, editors, or publisher.

Library and Archives Canada Cataloguing in Publication Data

Rural community health and well-being : a guide to action / edited

by: Robert Annis, Frances Racher, Marian Beattie.

Includes bibliographical references.

ISBN 1-895397-78-2 (paperback)

1. Rural health--Canada. 2. Rural health services--Canada.

I.Annis, Robert II. Racher, Frances III. Beattie, Marian

IV.Brandon University. Rural Development Institute.

RA771.7.C3R87 2004 362.1'04257'0971 C2004-907102-5

Foreward

Bill Reimer

Political analysts point to the ‘new governance’ as ‘the revolution that no one noticed’. They

refer to the many ways in which non-government and private sector groups have taken over

government functions – sometimes on their own, and sometimes in partnership. Health,

environmental enhancement, recreation, economic, and social support services that used to be

provided primarily by governments are now shared by complex systems of government,

private, and public partnerships or left to the purview of voluntary groups.

These new forms of governance make significant demands on civic groups yet these groups

are seldom given the knowledge and resources enabling them to do the job. Group

organization, information collection and analysis, knowledge development, conflict

resolution, partnership formation, and social action are usually a hit and miss affair – left up

to ad hoc learning with minimal support for the complexities of the new conditions. Such an

approach places civic groups at a disadvantage in their relationship with more formal

institutions and it undermines their ability to act effectively to meet the challenges they face.

Without strong and flexible civic engagement, this new form of governance is bound to fail.

It requires communities and groups that can investigate and represent their situation in terms

that are well founded and comprehensible. It requires debates on key values and objectives

that are transparent and inclusive, and it requires social action that is focused and strategic.

All these place additional demands on communities that are challenged already by change

and uncertainty.

This guidebook makes an important contribution to meeting those challenges. It provides key

tools for groups to identify the nature of the issues they face, gather appropriate information,

transform it into knowledge, and mobilize themselves and others to meet the new demands. It

supports a knowledge culture that promises to empower communities and produce

innovations in social organization that will prepare all of us for the surprises and demands of

the new century.

I congratulate the editors for their work and look forward to the new insights, activities, and

initiatives that will follow.

Bill Reimer

November 9, 2004

Betty Havens

It has been a pleasure and a privilege to watch this guidebook evolve and take form. Its

precursor, as a working draft, was both tentative and prescriptive; this is truly as it is subtitled

‘A Guide to Action’. This tool enables rural communities to develop the actions that they

need to undertake to ensure that their communities are healthy communities and that their

populations are healthy and secure.

The authors, participants, partners and communities that have developed this guidebook are

to be congratulated. They have collaboratively produced a tool that will be readily accessible

to assist local rural and more remote communities find the data that they need to produce the

plans that will evolve into the Actions that will move them forward as both healthy and

endowed with well-being.

The conceptual underpinning that is provided in the first three chapters and the process, as

detailed in chapter four, will lead to success by setting the stage and enabling each

community that chooses to do so to move toward an action plan of their own. This will

enable them to use, modify, interpret and sustain the actions laid out in the tools that

constitute the majority of this guide. Such collective and collaborative action will empower

communities to take true ownership of their own health and community development and the

health and development of every citizen, regardless of age, gender, ethnicity, socio-economic

status, residential tenure, and community roles.

Again, I congratulate all those involved in this excellent resource and eagerly await the

documentation of those communities that will take up the challenge of producing healthy

communities based on the use of this ‘Guide to Action’. In other words, I look forward to a

follow-up book of case studies and further development of the tools and conceptualizations.

Betty Havens

November 30, 2004

Rural Community Health and Well-Being: A Guide to Action

1

Table of Contents

Foreward.................................................................................................................................. 4

Bill Reimer......................................................................................................................................... 4

Betty Havens......................................................................................................................................5

Table of Contents.................................................................................................................... 1

Introduction and Acknowledgements................................................................................... 3

Chapter 1 - Community Development.................................................................................. 4

Frances Racher and Robert Annis...................................................................................................... 4

Community ...................................................................................................................................................4

Community Development.............................................................................................................................7

Health............................................................................................................................................................8

Quality of Life ..............................................................................................................................................8

The Determinants of Health and the Population Health Approach...............................................................8

Chapter 2 – Information Collection & Analysis ..................................................................9

Barbara Gfellner, Kim Ryan-Nicholls, Ryan Gibson, Katherine Pachkowski and Nicole Shirray ..9

Participatory Action Research ......................................................................................................................9

Establishing Research Goals.........................................................................................................................9

Research Ethics...........................................................................................................................................10

Data Sources ...............................................................................................................................................10

Samples.......................................................................................................................................................12

Methodology...............................................................................................................................................13

Quantitative vs Qualitative Information......................................................................................................15

Information Analysis ..................................................................................................................................16

Chapter 3 - Rural Community Health & Well-Being........................................................ 18

Frances Racher, John Everitt, Robert Annis, Barbara Gfellner, Kim Ryan-Nicholls, Marian Beattie,

Ryan Gibson and Elicia Funk ..........................................................................................................18

Rural Community Health & Well-Being Framework.................................................................................19

Indicators ....................................................................................................................................................20

Chapter 4 - Community Action........................................................................................... 38

John Everitt , Frances Racher and Marian Beattie ..........................................................................38

Community Health Action Model...............................................................................................................38

Communication...........................................................................................................................................40

Leadership...................................................................................................................................................42

Partnerships.................................................................................................................................................44

Team Development.....................................................................................................................................47

Consensus ...................................................................................................................................................49

Problem Solving .........................................................................................................................................50

Conflict Management..................................................................................................................................51

Effective Meetings......................................................................................................................................53

Planning for Action.....................................................................................................................................55

Evaluation...................................................................................................................................................58

Chapter 5 - Tools for Action................................................................................................ 61

Robert Annis, Ryan Gibson, Marian Beattie, Devron Kobluk, Katherine Pachkowski and Nicole

Shirray.............................................................................................................................................. 61

Population Indicators Worksheets ..............................................................................................................62

Health Indicators Worksheets.....................................................................................................................74

Safety & Security Indicators Worksheets .................................................................................................100

Rural Community Health and Well-Being: A Guide to Action

2

Economics Indicators Worksheets............................................................................................................113

Education Indicators Worksheets..............................................................................................................123

Environment Indicators Worksheets.........................................................................................................132

Community Infrastructure Indicators Worksheets....................................................................................147

Recreation, Heritage & the Arts Indicators Worksheets...........................................................................160

Community Processes Indicators Worksheets..........................................................................................169

Social Supports Indicators Worksheets.....................................................................................................177

Question Design........................................................................................................................................187

Surveys .....................................................................................................................................................195

Key-Informant Interviews.........................................................................................................................198

Focus Groups............................................................................................................................................201

Community Climate Chart........................................................................................................................204

Leadership Skills Assessment Checklist...................................................................................................205

Choosing the Most Appropriate Leadership Style....................................................................................206

Partner Identification Chart.......................................................................................................................207

Partnership Considerations .......................................................................................................................208

Partner Characteristics Checklist ..............................................................................................................209

Partnership Implementation Checklist......................................................................................................210

Group Effectiveness Checklist..................................................................................................................211

Group Participant Checklist......................................................................................................................212

Solutions Matrix .......................................................................................................................................213

Action Plan Form......................................................................................................................................214

Conflict Resolution Worksheet.................................................................................................................215

Meeting Planner Form ..............................................................................................................................216

Meeting Agenda Form..............................................................................................................................217

Detailed Meeting Agenda Form................................................................................................................218

Meeting Participation Checklist................................................................................................................219

Minutes Form............................................................................................................................................220

Goal and Objectives Worksheet................................................................................................................221

Workplan Worksheet ................................................................................................................................222

Evaluation Planning Worksheet................................................................................................................223

Guidelines for Engaging Evaluators .........................................................................................................226

References............................................................................................................................ 228

Glossary ............................................................................................................................... 238

Rural Community Health and Well-Being: A Guide to Action

3

Introduction and Acknowledgements

This Guide emerged from a Social Sciences and Humanities Research Council of Canada

funded research project that examined the determinants of health of rural populations and

communities. It is intended to be a “hands-on” tool that can be used by rural and northern

communities, and others, to look at the health and well-being of their communities from a variety

of perspectives. Chapters 1 – 4 provide information, insight and ideas for community

development, rural community health and well-being, and processes for community engagement

and action. Chapter 5 consists of a number of reproducible materials for use by communities.

Many people spent numerous hours contributing to the research and to the development of

the Guide. They include: Principal Research Investigator: Dr. Robert Annis, Director,

Rural Development Institute (RDI), Brandon University; Research Co-Investigators: Dr.

John Everitt, Department of Geography, Dr. Barbara Gfellner, Department of Psychology

and Dr. Fran Racher, School of Health Studies from Brandon University; Dr. Betty Havens,

Community Health Sciences from the University of Manitoba and Dr. Bill Reimer,

Department of Sociology and Anthropology from Concordia University. Research

Collaborators include: Dr. Ken Bessant, Department of Sociology; Dr. Nukte Edguer,

Department of Psychology; Dr. Noreen Ek, School of Health Studies; Dr. Doug Ramsey,

Department of Rural Development; Ms Renée Robinson, School of Health Studies; and Ms

Kim Ryan-Nicholls, School of Health Studies from Brandon University; and Mr. Earl

Backman from Brandon.

Participatory Action Research (PAR) underscored the entire project. PAR involves

participation in the research by people within communities, drawing on their knowledge and

personal experiences to contribute to the research agenda, processes and findings. Inter-

Communities Partners include: Assiniboine and Brandon Regional Health Authorities;

Community Futures Partners of Manitoba; Virden-Wallace Community Development

Corporation; and Wheat Belt Community Futures Corporation. The Guide was piloted and

tested in two rural southwestern and one northern Manitoba communities. RDI researchers

were invited into the communities and the communities fully participating in the research

project. Many thanks to the Community Assessment Team from the Town and Rural

Municipality of Shoal Lake, the Rural Lifestyle Assessment Project Team of the Town of

Virden and Rural Municipality of Wallace and the Community Advisory Committee in the

Town of Leaf Rapids. These community committees spend countless hours partnering with

the university researchers to gather information to better understand their communities. They

also provided invaluable feedback on the design, structure and content of this Guide. We

thank the Government Partners: Rural Secretariat, Agriculture and Agri-Food Canada; Health

Canada, Population and Public Health Branch; and Statistics Canada for contributing to the

project and the development of this Guide. Over the course of the project, there were many

RDI Contributors - Research: Marian Beattie, Pamela McTavish, Beth Peers, and Karen

Rempel; Administrative: Sylvia Henry and Bev Lischka; Student Research Interns: Elicia

Funk, Ryan Gibson, Lori Gould, Tanis Horkey, Devron Kobluk, Katherine Pachkowski and

Nicole Shirray; and Student Research Assistants: Amanda Campbell, Rebecca Cowan,

Sarah English, Elicia Funk, Zamira Gawletz, Ryan Gibson, Lori Gould, Mike Kolba, Mark

Matiasek, Amber Racher, Tara Romanyszyn and Catherine Taylor.

Rural Community Health and Well-Being: A Guide to Action

4

Interactions as a collective unit

(Being)

Expression of a sense of

community

(Belonging)

Community Action

(Becoming)

Adapted from Kulig in Ramp et al, 1999

A resilient community is one that takes intentional action to enhance the

personal and collective capacity of its citizens and institutions to respond to and

influence the course of social and economic change.”

(Centre for Community Enterprise, 2000).

Chapter 1 - Community Development

Frances Racher and Robert Annis

Community

A community is made up of people living in a

geographically localized area, who share some type of

common bond and interact on a regular basis. (Ramsey et

al, 2001).

A sense of “community” occurs when there are

• interactions as a collective unit – getting along, sense of

belonging, networks, both formal and informal; and

• expressions of a sense of community, or community

togetherness, (Kulig, 1999)

Community Resiliency

A combination of “interactions as a collective unit”,

“expression of a sense of community” and the community’s

reaction to stressors such as changes within the economy and

social structures results in community cohesiveness, which

includes common visions, goals, hopes and the lines of

defense, can withstand the stressors, placed on the

community and lead to action.

Increasingly, communities are facing significant social, economic and environment changes. In

order to survive they need to adapt to these changes. A community’s ability to determine their

level of resilience allows them to identify their weaknesses, and strategize how to overcome those

weaknesses.

Chapter

1

Rural Community Health and Well-Being: A Guide to Action

5

Community Resiliency Framework

Adapted from Neuman (1995) and Kulig (1999)

Resilient communities:

• utilize a multi-functional approach to sustainability (economically, ecologically, politically

and socially);

• maximize their use of limited time and resources in the areas that will yield the greatest

overall benefits;

• develop plans that merge social and economic goals, building local capacity;

• focus their energies on mobilizing internal financial and human assets, while leveraging

external resources; and

• establish a critical mass of co-operating organizations through which locally-based initiatives

are implemented and evaluated (Centre for Community Enterprise, 2000).

Dimensions and characteristics of a resilient community include:

People – beliefs, values, attitudes and behaviours.

• Leadership is representative of all sectors in the community.

• Elected officials are visionary, share power and build consensus.

• Community members are involved in major community decisions.

• People feel a sense of attachment and are optimistic about the future of their community,

encompassing a spirit of mutual assistance and co-operation.

• The community looks to itself and its own resources to address major issues.

• Belief in and support for education at all levels is evident in the community.

Stressors

Health &

Well Being

Assets &

Strengths

Community

Resiliency

Stressors

Community Action

(Becoming)

Interactions

collective unit

(Being)

Expression of

a sense

(Belonging)

-

as a

of community

Rural Community Health and Well-Being: A Guide to Action

6

Public, Private &

Non-Profit Institutions

Skills & Capacities of

Individuals

Capacity Finders

& Developers

Associations

Physical Assets

Community

Assets

Organizations – collaboration within local organizations, institutions and groups.

• Organizations have developed partnerships and collaborative working relationships.

Resources – internal and external.

• There is a diversity of employers within the community.

• There is openness to alternate ways of earning a living.

• The community has a strategy for increasing independent local ownership.

• The community looks outside itself for resources that will address its weaknesses.

Community Processes – planning, participation and action.

• Residents of the community are involved in the creation and implementation of the

community’s vision and goals, with regular evaluation of progress towards the goals.

• The community’s development approach encompasses all sectors of the population

(Centre for Community Enterprise, 2000).

Community Assets

Assets are the attributes of the community and are considered essential for the sustainability of the

economy, society and environment of the community. They are what the community wants to

keep, build upon and sustain for future generations (Fuller, et. al., 2002). Each community is a

unique combination of assets that includes the gifts, skills and capacities of its residents, an

inventory of the citizen’s associations, and the formal institutions that are located in the

community. When communities map their assets, the collect:

• an inventory of all the good things about their community;

• a ranking of the most valued aspects of the community; and

• why people place high value on those assets.

Adapted from Kretzmann & McKnight (1993)

Rural Community Health and Well-Being: A Guide to Action

7

Skills and Capacities of Individuals

How can the skills, talents and capacities of every individual in the community be

discovered? Usually a “capacity inventory” is developed. Once the information is collected,

how might these capacities be connected with each other to enhance the work of local

associations and institutions?

Associations of Citizens

What associations are present in the community? Some such as churches and service clubs

will be easy to locate. Others, such as coffee clubs, often informal and less public will be

more difficult to map. How are these associations connected to one another currently, and

how might they be connected in the future?

Local Institutions

What public institutions, not-for-profit institutions and businesses are located in the

community? How might these institutions reach out to a variety of individuals in the

community? How can these organizations be connected to each other and to local citizen

associations for mutual benefit?

Physical Assets

What does the community have in terms of land, buildings, streets, transportation systems,

infrastructure, etc.? How are these assets connected to individuals, associations and

institutions? What assets are underused? What new ways can be used for physical assets?

Capacity Finders and Developers

Every community has citizens who have a capacity-oriented view of the world. These are the

people who understand that the proverbial glass is both half-full and half-empty but who

insist on focusing first on the fullness, i.e. on the gifts and capacities of their fellow citizens.

These people may be the local leaders, but they may also be people who have not been

identified previously as leaders in the community.

Community Development

Community development is a process whereby a group of people in a community reach a

decision to initiate a social action process to change their economic, social, cultural or

environmental situation (Christenson & Robinson, 1980).

Community Development is community-based and people-centred; is inclusive; promotes

good practice; builds on strengths; ensures the decision-making comes from the community;

recognizes and develops expertise of community residents; requires assessment and does not

rely on assumptions; and is understood by those involved (Frank, 2001).

Community Development is for the community by the community towards

a shared vision with a broad base of community support.

Rural Community Health and Well-Being: A Guide to Action

8

Health is a resource of everyday living, an essential dimension of the quality of our lives

giving people the ability to manage and change their surroundings.

This view of health recognizes freedom of choice and emphasizes the roles of individuals

and communities in defining what health means to them. (Epp, 1986)

Health

Fundamental conditions for health are peace, shelter, education, food, income, a stable ecosystem,

sustainable resources, social justice and equity (Canadian Public Health Association, 2000).

Health enables individuals, families and communities to function to the best of their ability within

their environments. The population health approach focuses on the entire range of individual and

collective factors and conditions and the interactions among them that determine resources for

every day living.

Quality of Life

Quality of life can be defined as: “the degree to which a person enjoys the important possibilities

of his/her life.” (Atlantic Health Promotion Research Centre et. al., 2002) Quality of life implies

the opportunity to make choices and gain satisfaction from living (Annis, Racher, & Beattie,

2002) and is strongly linked with population health, social development and community

sustainability (Lomas, 1998).

The Determinants of Health and the Population Health Approach

Population health is an approach to health that aims to improve the health of the entire population

and to reduce health inequities among population groups. It looks at and acts upon the broad range

of factors and conditions that have a strong influence on our health (Health Canada, 2004).

Determinants of Health is the collective label given to the multiple factors that contribute to the

health of populations. The population health approach looks at the Determinants of Health and

their interactions that have shown to influence health over the life course.

“There is a growing body of evidence about what makes people healthy… there is

mounting evidence that the contribution of medicine and health care is quite

limited…on the other hand, there are strong and growing indications that other

factors such as living and working conditions are crucially important for a healthy

population. The evidence indicates that the key factors which influence

population health are: income and social status; social support networks;

education; employment/ working conditions; social environments; physical

environments; personal health practices and coping skills; healthy child

development; biology and genetic endowment; health services; gender; and

culture. Each of these factors is important in its own right. At the same time, the

factors are interrelated.” (Health Canada, 2004).

Rural Community Health and Well-Being: A Guide to Action

9

Chapter 2 – Information Collection & Analysis

Barbara Gfellner, Kim Ryan-Nicholls, Ryan Gibson, Katherine Pachkowski and Nicole Shirray

Participatory Action Research

Participatory action research (PAR) involves participation in the research by the people being

studied; inclusion of popular knowledge, personal experiences and other ways of knowing;

focuses on empowerment and power relations; consciousness raising and education of the

participants; and political action (Dickson, 2000; Health Canada, 1996; Potvin, et al., 2003).

“PAR … aims to empower participants through their participation in and control

of the research agenda, process, and findings; their critical awareness of the causes

of the problems studied; and their establishment of individual and community

change as a planned outcome. PAR has great potential to effectively incorporate

desirable, planned community outcomes, as it links research purposely with

community action and change” (Dickson, 2000).

Establishing Research Goals

In order to get specific, clear-cut results in research, there must be specific, discernable goals.

As such, these goals and objectives will provide ideas for questions to ask of the population

under study.

Reading up on similar research can help provide ideas for both objectives for the project and

specific questions for the interview. Also, looking at other sources of information (such as

Statistics Canada) can reveal whether some or all of the data is already available. Be careful

using the web, since some sites can be questionable. As a general rule, university and

government sites can be trusted; use discretion with other sites.

Chapter

2

Community research methodology blends a participatory action research approach with

established community development practices to ensure the research is driven by the

community, with the community and for the community.

Rural Community Health and Well-Being: A Guide to Action

10

Research Ethics

Providing Information

When gathering information, it is important that participants involved in providing

information and data are made aware of:

• the purpose of the research;

• the name of the researcher(s) and collaborating parties;

• the potential benefits;

• the tasks to be performed by participants;

• any anticipated inconveniences to participants;

• the rights of participants including:

• the right to refuse or withdraw at any time; and

• the right to confidentiality of personal information.

Anonymity and Confidentiality

Confidentiality and anonymity of information gathered from participants should be protected.

It is important to clarify with participants if and how information collected will be shared

with third parties.

Information Collection, Handling, and Retention

Only information that is relevant to the purpose of the project should be collected. The

person or organization collecting the information must store, handle, and transfer all records;

both written and unwritten (e.g., computer files and videotapes), in a way that ensures

privacy and security of the information. Information should be retained only as long as it is

necessary and destroyed when no longer needed.

Data Sources

A number of sources can be used to gather the information. These sources include

government sources, regional sources and community-based sources.

Government

Statistics Canada and Manitoba

Community Profiles are two main

government sources of information.

Statistics Canada is the national

data-gathering body that produces

statistics to help Canadians better

understand the country, its

population, resources, economy,

society and culture. Statistics Canada

provides objective statistical

information about the population and

demographics of the community.

National population censuses are

conducted every five years by

Statistics Canada, on years ending

Rural Community Health and Well-Being: A Guide to Action

11

with a 1 or 6 (i.e. 2006). Beyond the census of population, Statistics Canada also gathers

information on issues such as health services, safety and security, youth, immigrants and

economics. Much of the information from Statistics Canada is available from their website,

www.statcan.ca. Within the website, information is located primarily under the ‘Community

Profiles’ button (see figure adjacent). Information can also be found through ‘Our Products

and Services’ and CANSIM, a database of socio-economic information

(http://www.statcan.ca/english/ads/cansimII/index.htm).

Not all Statistics Canada information is available to the public through their website.

Statistics Canada catalogues are often housed regionally at various institutions such as

universities and libraries. These catalogues may contain information that is not reported on

their website or further detail on information that is contained within the website. Further to

the website and the catalogues, Statistics Canada, through the Data Liberation Initiative

(DLI), provides Canadian academic institutions with access to Statistics Canada information

that is neither contained in the catalogues nor the website. Detailed information on surveys,

such as the Canadian Community Health Survey (CCHS), is available through institutions

with a DLI agreement. Often universities have DLI agreements with Statistics Canada and

are good contacts for information.

It should be noted that information generated by Statistics Canada are rounded off to the

nearest zero or five. In small samples, information results are suppressed by Statistics Canada

to maintain confidentiality. Consequently, certain columns and rows of numbers may not add

precisely due to this procedure.

Manitoba Community Profiles is a website available at www.communityprofiles.mb.ca. This

site provides the most comprehensive listing of information on communities and regions of

Manitoba. Each community profile offers up-to-date information covering everything from

location (maps) to quality of life indicators (demographics, population, labour force,

education, history, recreational facilities) to economic indicators (utilities, transportation,

taxation, land, buildings & development). Staff of Manitoba Intergovernmental Affairs

maintain the Manitoba Community Profiles website.

Other government sources of information that may be useful include contacting federal and

provincial departments and agencies, such as Health Canada or Manitoba Education &

Training. Often departments/agencies collect information on programs and activities offered,

which may be pertinent. Contact information for these departments can be found in telephone

books or through the Internet.

Regional

Although regional sources of information often are often not collected on a community,

regional information can be very useful in representing trends within the population.

Examples of regional sources of information include regional health authorities and school

divisions.

Rural Community Health and Well-Being: A Guide to Action

12

Community

Community-based sources are information that is collected locally, usually since it is not

available through other data sources. Community-based information may include documents

such as local reports and information gathered through interviews with relevant members of

the community.

Samples

There are two main decisions involved in choosing a sample. First, decide who should be in a

sample (this group is known as the target population, or sampling frame). This could

include all members of a community, or it could be a subgroup, such as long-term residents.

This decision is very important, since interviewing the wrong kinds of people will often give

unusable results. Second, decide how many people will be in the sample. Researchers rarely

ask every individual in a population, since a representative sample will usually give the

same results at a much lower cost. The time available, budget, and necessary degree of

precision for the project will all contribute to deciding sample size. Before selecting a

sample, ensure that the contact list for the target population is complete and accurate. Simply

looking in the phone book won’t account for households without phones, unlisted numbers,

and multiple listings. Selecting names randomly will go a long way towards making the

sample representative. A random sample helps to minimize any biases, or errors, in the

results. Below are two simple and commonly used methods for choosing such a sample.

Remember that there are more available, each with different variations.

Simple Random Sample

A simple random sample is drawn randomly from a complete list of individuals or

households in a population. This is useful when all individuals are considered equal with

respect to the study.

Stratified Random Sample

A stratified random sample groups the population into subcategories (based on age, income,

length of time as a resident, etc.) and random samples are drawn from each group. This

ensures that each group is adequately represented in the results.

Sampling and Non-Sampling Error

Sampling error occurs when the sample population differs in some way from the target

population. There are two main sources of sampling error, Sampling bias and probability.

Sample bias arises from the selection process. For example, if an individual is listed twice

this doubles their chance of being selected. The best way to check for selection bias is to find

out if the sample is representative of the target population. To do this, compare important

variables of the sample to those of a reliable census, such as the data from Statistics Canada,

to see if they are similar. Good characteristics to compare include age, sex, income, and

education. Eliminating all bias is next to impossible, but it is important to minimize it in

order to increase the credibility of the data. Probability is simply the luck of the draw. There

is no way to eliminate all error in a sample; for example, the sample might draw only females

simply by chance. However, if the sample is big enough this error can be minimized so that it

doesn’t affect the results too strongly. Errors related to the design and application of

information gathering methods is known as non-sampling errors. Being familiar with these

Rural Community Health and Well-Being: A Guide to Action

13

common issues will also help you decide on a methodology that will work best in your

situation.

A change in the definition of the needs of the target population over time can happen when

some important event occurs during the information gathering time. To avoid this, use

careful timing and planning based on an understanding of the political and social context of

the population: e.g. make sure there is no town meeting planned during the data gathering.

Non-response

If people aren’t responding because of a particular reason (for example, they can’t read the

questionnaire, they’re not home during the day, or they don’t feel comfortable talking on the

phone) then you may be missing an important subgroup of the population. This could also

apply to individual questions if they are worded poorly, or perceived to be insulting or too

embarrassing to answer.

Measurement design

When designing the information gathering method ensure that respondents feel comfortable

enough to answer truthfully and make sure that the questions are worded properly so that

respondents are able to answer truthfully. Being comfortable refers to the type of information

gathering method chosen. Some people don’t like talking on the phone, while others are not

able to read well enough to complete mail surveys. The wording of questions will be

addressed later.

Methodology

There are several methods of collecting data from a population, each with advantages and

disadvantages. Determine which is the most applicable for the situation, remembering that

more than one method is often best. Questions to keep in mind include:

• How accurate will the information be (based on advantages/disadvantages of each

method)? Will it look credible to decision makers (for example, politicians, business

owners, etc.)?

• Will the method get all of the required information? If not, what additional method(s)

should and could be used to gather the other information?

• Will the nature of the respondents conform to the methods (fill out the questionnaires

carefully, engage in focus groups, etc.)?

• Who can administer the methods now or is training required?

Rural Community Health and Well-Being: A Guide to Action

14

Page 195

Page 201

Surveys and Questionnaires

Surveys and questionnaires are used to collect information to describe,

compare or explain knowledge, attitudes and behaviour. Surveys allow

researchers to collect and organize large amounts of information that is not

readily available from existing data sources. They consist of groups of

questions designed to collectively probe into issues of relevance to an

organization, program or project.

Questions may be open or closed-ended. Open-ended questions require a narrative response

and do not limit the range of responses provided by the respondents. The responses have

more depth and breadth than closed-ended questions.

Closed-ended questions provide respondents with a guideline or context for their response.

Data can be collected through logical responses such as “yes” or “no”; likert scales that

provide a range of possible responses; and multiple responses that provide respondents with a

number of pre-coded responses.

Surveys should have specific measurable objectives; sound research design; sound choice of

population or sample, reliable (consistent) and valid (accurate) instruments; appropriate

analysis and accurate reporting of survey results. To be effective, expert advice should be

sought on the design of the survey, the selection of respondents to be contacted, and the

analysis of the findings.

Focus Groups

A focus group is a group of individuals who have been selected to discuss and

comment, from their personal experiences, a topic that is the subject of

research. Focus groups rely on interaction within the group. The main

purpose of using focus groups is to draw on the participants’ attitudes,

feelings, beliefs, experiences and reactions in a way that is not feasible using

other methods. These attitudes, feelings and beliefs are more likely to be revealed in a social

gathering and the interaction within the group. Focus groups draw out multiple views and

opinions within a group context. In a focus group meeting, invited participants are given a

few open-ended questions to discuss. During the focus group meeting, the facilitator

encourages participant to express their feelings and opinions by asking open-ended questions,

promoting debate, and steering the discussion to keep it on course. The facilitator ensures

that everyone participates and gets a chance to speak, while avoiding giving his or her own

personal opinions. The discussion points that are raised are recorded. The information

gathered is later analyzed.

Rural Community Health and Well-Being: A Guide to Action

15

Page 198

Key-Informant Interviews

Key informant interviews are similar to focus groups; however each participant is

interviewed individually. Informant interviewees are usually selected based on

defined criteria, have personal knowledge of the topic to be discussed, and are able

to express them clearly.

Quantitative vs Qualitative Information

Quantitative data is information that is often considered “hard data” which can be counted,

tabulated and measured. Qualitative data is information that is often considered “soft data” and is

obtained through interactions with people, such as interviews, focus groups and story telling.

Quantitative Qualitative

Questions Focus is context- free:

• isolates variables, measures

their presence and their co-

relationship to other

variables.

Focus is context-rich:

• looks at variables in a social

context, seeks to understand how

& why by exploring people's

experiences/stories.

Sample Focus is on size:

• relies on statistics such as

descriptive, correlation,

probabilities; therefore needs

a large sample size to do the

mathematical equations or

documentation in a

meaningful way.

Focus is on representation:

• relies on speaking to a

representative sample based on

your focus; therefore sample size

is less important--what is more

important is capturing a range

and diversity of experience.

Methodology Focus is on counting:

• methods include

questionnaires, surveys,

standardized scales.

• answers must be countable.

Focus is on experiences:

• methods include focus groups,

interviews, case studies.

Rural Community Health and Well-Being: A Guide to Action

16

Information Analysis

Analyzing the information or data is the process of giving meaning to the information that has

been collected. Although often associated with being onerous and difficult, data analysis does not

have be complicated to be of value. The task of analyzing the information collected is essential to

assessing indicators and situations. The process of analyzing may involve a number of different

techniques, such as comparisons, categorizing or tabulating.

Presenting meaningful information is an important component of analyzing data. In order to make

the information collected useful to community members and organizations, the data needs to be

presented clearly and accurately. The type of data collected and how the data was collected will

influence the type of analysis. As a general rule, qualitative data is usually analyzed through

means such as categories, themes and detailed-description while quantitative data is analyzed

through using rates, ratios and comparisons.

Quantitative data, such as population or demographic data from Statistics Canada, should be

reported as both a total number and as a percentage of the total population value. A general

formula for calculating the percentage of the total population value is:

%100

_

_=x

populationtotal

populationselect

Examining the percentage of the total population allows for comparisons between a community

and other jurisdictions, such as regions or provinces. Percentage of the total population values also

allow for comparisons over given time periods, such as between Census years (see Table 1).

Table 1: Age Breakdown of Community and Manitoba, 1996-2001

Community Manitoba

Age 1996 % 2001 % 1996 % 2001 %

Total 1420 100 1381 100 1,113,898 100 1,119,580 100

Children

(1-14) 240 17 230 16.7 244,615 22 233, 715 20.9

Youth

(15-24) 130 9.2 140 10.1 153,790 13.8 153,275 13.7

Adults

(25-64) 615 43.3 605 43.8 563,330 50.6 576,170 51.5

Seniors

(65+) 440 31 410 29.6 152,165 13.7 156,410 14

Source: Statistics Canada, 1996 & 2001

Qualitative data, such as information received through key-informant interviews and focus groups,

can be reported in a variety of ways. Often commonalities from respondents are grouped into

similar categories or themes. This allows percentages to be calculated and compared over

jurisdictions and time. Qualitative data may also be presented in detailed-description. For

example, Internet access at a public library could be documented with details on the hours of

operation, the number of computers available, costs associated with the service and how frequent

Rural Community Health and Well-Being: A Guide to Action

17

the service is used. The richer detail provided the greater the value in the data. Detailed-

description provides valuable information that can easily be forgotten or overlooked.

Regardless of the type of data and how it was collected, all data analysis and presentation of data

should include the source of the data (for example: Statistics Canada or Manitoba Agriculture,

Food and Rural Initiatives), the date the data was collected (for example: 2004) and the limitations

that are associated with the data or the data source (if any).

To ensure that the confidentiality or anonymity of respondents is maintained, diligence must be

exercised when reporting information. As a general rule, variables with less than 5 reported cases

should not be recorded as the identity of these individuals may be easily recognized. In these

cases, it will be necessary to aggregate the data to create variables with greater than 5 reported

cases.

Rural Community Health and Well-Being: A Guide to Action

18

Chapter 3 - Rural Community Health & Well-Being

Frances Racher, John Everitt, Robert Annis, Barbara Gfellner, Kim Ryan-Nicholls, Marian Beattie, Ryan Gibson

and Elicia Funk

Why is Jason in the hospital?

Because he has a bad infection in his leg.

But why does he have an infection?

Because he has a cut on his leg and it got infected.

But why does he have a cut on his leg?

Because he was playing in the junk yard next to his apartment building

and there was some sharp, jagged steel there that he fell on..

But why was he playing in a junk yard?

Because his neighbourhood is kind of run down.

A lot of kids play there and there is no one to supervise them.

But why does he live in that neighbourhood?

Because his parents can't afford a nicer place to live.

But why can't his parents afford a nicer place to live?

Because his Dad is unemployed and his Mom is sick.

But why is his Dad unemployed?

Because he doesn't have much education and he can't find a job.

But why ...?

(Health Canada, 1999)

Health can be viewed as complex interaction among various factors. One factor may lead to

others, which, in turn, lead to others, all of which interact with one another (Vollman et al, 2004).

Chapter

3

Rural Community Health and Well-Being: A Guide to Action

19

Social Economic

Environment

Health

Population

Social

Supports

Community

Processes

R

ecreation

Heritage

Arts Community

I

nfrastructure

E

nvironmen

t

E

ducation

E

conomics

Safety

&

S

ecurity

Being Belonging Becoming

Rural Community Health & Well-Being Framework

Rural Canadians are increasingly concerned about the health of their communities. People

and organizations use frameworks, models (plans made up of categories) and indicators or

measures to understand and assess the world in which they live. Social, economic and

environment factors are common to many health and well-being frameworks. Emerging out

of these categories are additional categories that rural residents identified as important

considerations and additions to the framework. Input from a variety of rural participants led

to the development of this model of ten categories and related indicators for use in rural

communities. This framework, including indicators was refined following the two pilot

projects where two rural communities used the framework and indicators to gather

information about their communities. As residents of rural communities assess their

communities' health, well-being, and quality of life they discover the current state of their

community, Being; the fit of their community with the broader environment, Belonging; and

what activities are required to achieve community goals, hopes and aspirations, Becoming

(Raphael, 1999).

©Rural Development Institute, Brandon University.

Rural Community Health and Well-Being: A Guide to Action

20

R

esidents o

f

rural communities said:

"The kids that are staying around are those that are

not educated…the others are educated beyond this

p

lace and the

y

leave.

"

"We have an aging population that is not being

replaced by youth."

"We need to be more tolerant…if you are a unique

individual it is more difficult to fit into a rural

community."

"At one time I couldn't wait to get out of here, now

I

'm content to sta

y

here the rest o

f

m

y

li

f

e. I have no

idea why that changed."

Indicators

An indicator is a measure that tells us something about a larger topic. Indicators are a way of

seeing the ‘big picture’ by looking at smaller pieces of it. The information gathered related to

these smaller pieces can be used to compare aspects of community health and well-being over

time to see if there has been improvement or change in the community. Indicators can also be

used to compare one community with another. Indicators in this guide have been selected because

they are understandable and easy to interpret; have data sources that are accessible and available

on a consistent basis; measure something that is important to citizens of rural communities; are

credible and acceptable to citizens of small rural communities; and are based on scientific,

traditional or community knowledge that is reliable, trustworthy and relevant.

Population Indicators

The demographic characteristics of

individuals living in a community can

affect the health and well-being of that

community. For example, young people

staying in or returning to their

communities, aging populations who are

living longer, and increases or declines

in the population of the community are

some issues in this regard. The culture,

heritage and ethnic diversity of the

population is also important when

examining the make-up or composition

of a population in a rural community.

Tool

Population By Five Year Age Group

• data on age structures and gender are useful in determining need

for and allocation of resources for education, day care, health care,

and many other social services

Worksheet # Pop-1

Page # 62

Population By Gender Group (Male/Female)

• data on age structures and gender are useful in determining need

for and allocation of resources for education, day care, health care,

and many other social services

Worksheet #Pop-2

Page # 63

Migrant Population

• indicates the mobility among residents and may be a sign of

economic or social gain/loss in a community that could be

investigated to understand causes and identify strategies for action

Worksheet # Pop-3

Page # 64

Home Language

• may indicate a need for services in languages other than English Worksheet # Pop-4

Page # 65

Rural Community Health and Well-Being: A Guide to Action

21

Tool

Ethnicity

• indicates ethnic composition and community diversity Worksheet # Pop-5

Page # 66

Education Attainment Level

• may be used to compare graduation rates over time. Education

attainment levels correlate with socio-economic status

Worksheet # Pop-6

Page # 67

Population Growth/Loss

• indicates demographic change in a population Worksheet # Pop-7

Page # 68

People Living Alone

• may be used as an indirect measurement of social isolation which

may imply deprivation of social relations

Worksheet # Pop-8

Page # 69

Census Families

• represents the composition of the community by family status Worksheet # Pop-9

Page # 70

Population By Marital Status

• represents the composition of the community by marital status Worksheet # Pop-10

Page # 71

Labour Force Replacement Ratio

• is useful in predicting the future available labour force. If the

number is greater than 1 there is a surplus of potential labour.

Worksheet # Pop-11

Page # 72

Population Dependency Ratio

• indicates the economic responsibility of the working age

population for those that are not working

Worksheet # Pop-12

Page # 73

Rural Community Health and Well-Being: A Guide to Action

22

R

esidents o

f

rural communities said:

"The home care in our community is incredible and

maintains so man

y

people outside the

f

acilit

y

where the

y

are leading wonderful lives. It is not about a building."

"We need to look after our own people."

"There's lots of travel to get more medical care. That's

p

robabl

y

one o

f

the choices

y

ou make when

y

ou decide

to live rural."

"Half the people [in Manitoba] live in Winnipeg, but

half don't."

Health Indicators

Health services and programs,

particularly those designed to

maintain and promote health, to

prevent disease, and to restore and/or

manage health and function contribute

to the overall health and well-being of

the community. Residents of rural

communities are concerned about

access to and level of services,

availability and quality of services,

gaps in these services, as well as

health staff recruitment and retention.

Rural residents recognize the

importance of rural health resource

allocation and the processes used to

make these decisions.

Quality of Life Tool

Self-Perceived Health

• perception of health may be an overall indicator of health status Worksheet # H-1

Page # 74

Community Health Promotion Events And Activities During A 1-

Year Period

• may indicate the extent of health education programs available in

the community

Worksheet # H-2

Page # 75

Collaborative Partnerships With Other Communities For Health

Promotion Events And Activities

• shows the amount of community collaboration for health promotion

Worksheet # H-3

Page # 76

Self-Perceived Health Care Needs

• indicates residents’ perceptions of their health care needs Worksheet # H-4

Page # 77

Reported Smoking

• smoking is linked to increased risk of poor general health, mortality

linked to cardiovascular disease, cancer, and respiratory problems

Worksheet # H-5

Page # 78

Alcohol Consumption

• consumption of alcohol may be linked to personal, family and

health problems

Worksheet # H-6

Page # 79

Physical Activity

• engagement of community residents in physical activity may be

seen as a measure of quality of life

Worksheet # H-7

Page # 80

Reported Obesity

• obesity is an established risk factor for coronary heart disease,

diabetes, and certain types of cancer

Worksheet # H-8

Page # 81

Preschool Child Screening

• identifies developmental problems and potential need for resources Worksheet # H-9

Page # 83

Rural Community Health and Well-Being: A Guide to Action

23

Tool

Immunization Programs

• indicates the extent to which residents have been protected against

diseases

Worksheet # H-10

Page # 84

Health Status

Selected Diseases And Disorders

• change in incidence rates of certain diseases and disorders may

identify areas of concern for action

Worksheet # H-11

Page # 85

Communicable Diseases

• change in incidence rates of communicable diseases may identify

areas of concern for action

Worksheet # H-12

Page # 86

Selected Cancers

• change in the incidence rates of cancer may contribute to

identification of environmental and other factors linked with certain

types of cancer

Worksheet # H-13

Page # 87

Causes Of Death

• may be important for determining future health prevention and

promotion activities

Worksheet # H-14

Page # 88

Health Service Availability and Utilization

Health Services Availability

• measures health services available to the community Worksheet # H-15

Page # 89

Hospital Services Utilization

• indicates where people are going for and who is using hospital

services

Worksheet # H-16

Page # 90

Hospital Occupancy Rate

• shows the hospital usage Worksheet # H-17

Page # 97

Home Care Utilization

• indicates the availability and utilization of home health supports Worksheet # H-18

Page # 98

Personal Care Homes Utilization

• indicates the availability and utilization of services for residents who

need the level of care that personal care homes provide

Worksheet # H-19

Page # 99

Rural Community Health and Well-Being: A Guide to Action

24

R

esidents o

f

rural communities said:

" A healthy community is a safe place. You can

s

end the children outside, and

y

ou know even the

neighbours will look out for them".

"You can always call someone if you need help,

even at 2 a.m."

"Safety—I feel safer here than I would in the

city. I can walk alone at night and not be

s

cared.

"

Safety and Security Indicators

Personal safety, farm safety, crime and

vandalism, available and effective

emergency services, kinds and types of

community support programs can be

measured to determine the health and well-

being of people within rural communities

and the quality of life of the community.

Emergency Preparedness Tool

Emergency Programs

• shows the degree to which a community is prepared for disasters

that may occur. Regular training of emergency personnel, testing

and adjusting of the plan indicates that municipal, town and regional

health authority leaders are practicing a proactive approach to

disaster preparedness

Worksheet # Saf-1

Page # 100

Community Safety And Security Programs

• shows involvement of participants in community safety and security

programs such as Neighbourhood Watch, Block Parent, Citizens on

Patrol, Juvenile Justice

Worksheet # Saf-2

Page # 101

Emergency Response

Ambulance Responses

• measures the activity of the ambulance service which may have an

impact on emergency services planning

Worksheet # Saf-3

Page # 102

Emergency Service Response Times

• may measure changes for each emergency service over time Worksheet # Saf-4

Page # 103

Safety & Security

Reported Industrial Injuries

• indicates the prevalence of industrial injuries and may identify

issues related to industrial safety practices

Worksheet # Saf-5

Page # 104

Reported Farm Injuries

• indicates the prevalence of farm injuries and may identify issues

related to farm safety practices

Worksheet # Saf-6

Page # 105

Crimes Against Persons

• a measure of violent behavior in the community

Worksheet # Saf-7

Page # 106

Crimes Against Property

• a measure of security in the community Worksheet # Saf-8

Page # 107

Rural Community Health and Well-Being: A Guide to Action

25

Tool

Reported Domestic Violence

• the incidence of reported domestic violence identifies issues related

to family health and well being

Worksheet # Saf-9

Page # 108

Juvenile Convictions

• may indicate youth issues in the community Worksheet # Saf-10

Page # 109

Motor Vehicle Accidents

• is an indicator of the level of mortality and morbidity related to

traffic accidents

Worksheet # Saf-11

Page # 110

Resources

Human Resources

• indicates the human resources and community involvement with

emergency services

Worksheet # Saf-12

Page # 111

Financial Resources

• indicates the financial resources available for emergency services Worksheet # Saf-13

Page # 112

Rural Community Health and Well-Being: A Guide to Action

26

R

esidents o

f

rural communities said:

" We just want an honest day’s wages for an honest

day’s work. That’s what farmers are about".

"We are influenced by the uncertainties the farmers are

f

acin

g

ri

g

ht now, and it's a

ff

ectin

g

the health o

f

the

community."

"We need a good diverse area with industry to keep

y

outh in the communit

y

. I

f

we don't have them, we

don't have much…we need jobs for them to do, to entice

them to stay here. In order to keep them here we need

s

ervices. We are losin

g

too man

y

people, too man

y

s

ervices."

Economics Indicators

The number, type, and diversity of

businesses within communities, skill

of the labour force, employment and

training opportunities, and the cost of

living are indicators of health and

well-being of communities. In

addition, reliance on the agricultural

economy has an impact on the health

of rural communities influencing

diversification, degree of stress and

need for crisis management.

Socio –Economic Tool

Low-Income Cut Off Point (Poverty Line)

• measures the population living below the poverty line or low

income cut off point

Worksheet # Ec-1

Page # 113

Sources Of Income

• indicates the extent of diversity of income sources Worksheet # Ec-2

Page # 114

Community Affordability

• measures the cost of a “basket of goods” (food, housing, recreation,

clothing, day care, and fuel) locally compared to the province and

their region, and can show, over time, whether goods are costing

more or less

Worksheet # Ec-3

Page # 115

Employment

Unemployment

• measures the proportion of people who do not have employment

and who are likely to have unfavorable living conditions, decreased

household income and fewer social opportunities

Worksheet # Ec-4

Page # 116

Employers In The Community

• shows the distribution of the labour force and diversity of

business/industry in the community

Worksheet # Ec-5

Page # 117

Employees Commuting Into The Community To Work

• shows the migration of people into the community for employment

and may show a lack of skilled labour within the community

Worksheet # Ec-6

Page # 118

Employees Commuting Out Of The Community To Work

• shows the migration of community residents to other communities

for employment

Worksheet # Ec-7

Page # 119

Rural Community Health and Well-Being: A Guide to Action

27

Tool

Off-Farm Employment Income

• shows the number of farm residents over the age 15 who work off

the farm

Worksheet # Ec-8

Page # 120

Business & Industry

Business Start-Ups Within The Past Year

• measures of the growth in the community Worksheet # Ec-9

Page # 121

Succession Plans

• businesses and farms with succession plans show the extent of

planned transition for continuance of businesses and farms

Worksheet # Ec-10

Page # 122

Rural Community Health and Well-Being: A Guide to Action

28

R

esidents o

f

rural communities said:

"In order to keep a town going, you need

y

oun

g

f

amilies livin

g

there, and

y

ou have

to have schools for your kids. Otherwise

y

ou die out.

"

"In a healthy community, we need to have

literacy programs and a good education

sy

stem.

"

"I think learning opportunities should be

available not just to kids but to the whole

community."

Education Indicators

Effective education for children and lifelong

learning for adults are key contributors to health

and prosperity for individuals and for their

communities. Education contributes to health

and prosperity by equipping people with

knowledge and skills for problem solving and

helping to provide a sense of control and mastery

over life circumstances. It increases

opportunities for job and income security and job

satisfaction. Early childhood education, basic

and post-secondary education, literacy,

continuing and life-long learning are all

contributors to health and well-being of

individuals and communities.

Preschool Tool

Preschool Programs

• the presence of preschool programs in a community has

implications for healthy child development

Worksheet # Ed-1

Page # 123

Kindergarten-Senior 4 (Grade 12)

School Enrollment

• may identify resources available for education Worksheet # Ed-2

Page # 124

Student-Teacher Ratio

• may identify resources available for education Worksheet # Ed-3

Page # 125

Multi-Grade Classes

• the numbers of multi-grade classes may indicate availability and

allocation of resources

Worksheet # Ed-4

Page # 126

Multi-Grade Courses

• the numbers of multi-grade courses may indicate the availability

and allocation of resources

Worksheet # Ed-5

Page # 127

Students Traveling To School Be School Bus

• the numbers of students traveling to school may indicate the

availability and allocation of resources

Worksheet # Ed-6

Page # 128

Time Spent By Students Traveling To School By School Bus

• the time spent traveling to school may indicate the availability and

allocation of resources

Worksheet # Ed-7

Page # 129

Rural Community Health and Well-Being: A Guide to Action

29

Tool

Distance Delivered Courses

• shows the diversity of education available for high school students.

Proportion of courses delivered by distance methods may be an

indicator of flexibility and variety of learning options, as well as

availability and allocation of resources

Worksheet # Ed-8

Page # 130

Adult

Academic upgrading, continuing education courses

• may be an indicator of flexibility and variety of learning options, as

well as availability and allocation of resources

Worksheet # Ed-9

Page # 131

Rural Community Health and Well-Being: A Guide to Action

30

R

esidents o

f

rural communities said:

"We had our water chemically tested and there were

traces of 2-4-D and it's 90 feet deep."

"The quality of air in rural areas has started to diminish

because of large feedlots and spraying. Even though we

think of our environment as being pristine, I think that

has started to change. We need to be aware of it and

taking steps to reverse that while it is reversible."

"There is an Aboriginal idea that decisions should be

made with the consideration of what happens to the 7th

g

eneration."

Environment Indicators

Rural people are connected to the

land and strive for balance as they

make their living from the land

while seeing themselves as stewards

of the land. A healthy natural

environment promotes health while

at certain levels of exposure

contaminants in air, water, food and

soil can cause a variety of adverse

health effects. In the built

environment, factors relating to

indoor air quality, noise, and

building design can significantly

influence physical and psychological

well-being.

Water Tool

Community Water Usage

• usage of water has an impact on water sources and planning for the

future

Worksheet # En-1

Page # 132

Tested Wells

• may identify the need for awareness of testing well water. Test

results may indicate a need for action.

Worksheet # En-2

Page # 133

Waste Management

Community Sewage Treatment

• indicates households covered by the community sewage treatment

system and those who are on septic tanks

Worksheet # En-3

Page # 134

Recycled Material

• may show a community’s commitment to waste reduction. Worksheet # En-4

Page # 135

Hazardous Waste Disposal

• may show a community’s commitment to waste disposal. Worksheet # En-5

Page # 136

Air Quality

Outdoor Air Quality Infractions

• shows the extent to which the outdoor air quality is monitored and

may identify issues

Worksheet # En-6

Page # 137

Indoor Air Quality Infractions (Such As No-Smoking)

• shows the extent to which the indoor air quality is monitored and

may identify issues

Worksheet # En-7

Page # 138

Rural Community Health and Well-Being: A Guide to Action

31

Tool

Farming Practices

Intensive Livestock Operations (ILO)

• indicates the extent to which intensive livestock operations are in

the area

Worksheet # En-8

Page # 139

Certified Organic Farms

• measures the use of chemical–free farming practices Worksheet # En-9

Page # 140

Farm Inputs

• shows the extent to which farm in puts are used Worksheet # En-10

Page # 141

Stubble Burning Practice

• represents a practice that has the potential for respiratory problems

for nearby residents

Worksheet # En-11

Page # 142

Natural Resources

Unexpected Wildlife Deaths

• some wildlife deaths are attributable to causes that potentially have

an impact on the health of humans (e.g. West Nile Virus)

Worksheet # En-12

Page # 143

Designation Of Local Natural Areas

• may show measures towards protecting the natural environment Worksheet # En-13

Page # 144

Community Appearance

• attractiveness of the community may indicate the community’s

commitment to the health and quality of life of its residents

Worksheet # En-14

Page # 145

Community Green Spaces And Beautification Programs

• green spaces and beautification plans within a community may

indicate community commitment to the health and quality of life of

its residents

Worksheet # En-15

Page # 146

Rural Community Health and Well-Being: A Guide to Action

32

R

esidents o

f

rural communities said:

"A range of services and supports and facilities

and resources that meet a variety of human

needs. You need to have good schooling, health

care seniors' programs…. when you think of

s

maller communities tha

t

have died around us,

it's because they don't have those things. They

have moved to towns where those needs can be

met."

"We don't have to drive anywhere either. You

can walk or bike."

"Manitoba Housing built a lot of one-room

s

uites, but the

y

are not suitable for anyone. We

need two and three bedroom houses."

Community Infrastructure Indicators

Accessible and affordable transportation,

communication systems, housing, industrial

infrastructure, as well as availability and

access to public services are important to

rural residents. Community infrastructure

including roads, water and sewer services,

and effective municipal services such as

waste management and recycling are

increasingly important to rural communities

Tool

Public Meeting Spaces

• accessible and available public meeting places facilitates community

communication and social/recreational opportunities

Worksheet # Ci-1

Page # 147

Land Use

• shows current land use and development Worksheet # Ci-2

Page # 148

Industrial Infrastructure

• industrial infrastructure may be a factor in attracting new or

expanding industries

Worksheet # Ci-3

Page # 149

Public Utilities

• types and quality of current public utilities structures may limit or

enhance the opportunity for future development or a need for

infrastructural upgrades

Worksheet # Ci-4

Page # 150

Transportation

Availability Of Scheduled Transportation

• accessibility to public transportation may have an impact on

residents’ ability's to access employment, education, health services

and social/recreational opportunities

Worksheet # Ci-5

Page # 151

Availability Of Private Transportation

• indicates accessibility within and outside the community Worksheet # Ci-6

Page # 152

Rural Community Health and Well-Being: A Guide to Action

33

Tool

Availability Of Sidewalks, Walking/Bicycle Paths

• may indicate the community’s commitment to support healthy living

of its residents

Worksheet # Ci-7

Page # 153

Designated Parking Spaces

• indicates appropriate infrastructure and services for community

residents

Worksheet # Ci-8

Page # 154

Communication

Communication Media

• demonstrates connectivity with and beyond the community Worksheet # Ci-9

Page # 155

Public Internet Access Site(s)

• publicly accessible internet site(s) provide access for those people

without computers, and enable them more options

Worksheet # Ci-10

Page # 156

Housing

Residential Dwellings

• the numbers and types of residential dwelling units may have an

impact on the quality of life for residents such as the elderly and

persons with disabilities

Worksheet # Ci-11

Page # 157

Home Ownership

• indicates investment in the community and the ability to own

housing

Worksheet # Ci-12

Page # 158

Subsidized Housing Units

• availability of subsidized housing may have a socio- economic

impact on the community and its residents

Worksheet # Ci-13

Page # 159

Rural Community Health and Well-Being: A Guide to Action

34

R

esidents o

f

rural communities said:

"I think sports and recreation. Everything's

tied a little closer together in a smaller

community."

"Many families need money, that is why they

don't join."

"I just came from the rink where there were

56 seniors curling. 56! That's marvelous. I

s

ee a positive movement with exercise and

s

ports.

"

Recreation, Heritage & the Arts Indicators

Recreation can be defined as all activities chosen by

a person or group to make leisure time more

interesting, more enjoyable and more satisfying

(Manitoba Culture, Heritage and Tourism). Heritage

encompasses all areas of our past that construct our

social, economic and spiritual identity

(Saskatchewan Municipal Government). The Arts

include visual, performing and literary arts (Alberta

Recreation and Parks).

Recreation and leisure opportunities and options,

access to the arts, libraries, museums, churches,

activities for all ages, and links to neighbouring

communities are important to rural residents. As

physical activity is increasingly recognized as

contributing to health, the importance of services

and programs for sports and recreation grows.

Recreation Tool

National, Provincial And Community Parks

• Provincial and national parks may provide access to recreation

activities such swimming, boating, hiking, interpretive programs,

camping and fishing

Worksheet # Rec-1

Page # 160

Recreational Facilities

• opportunities for activities have an impact on the quality of life and

health of residents of the community

Worksheet # Rec-2

Page # 161

Organized Recreational Events And Activities

• opportunities for recreation and activities have an impact on the

quality of life and health of residents in the community

Worksheet # Rec-3

Page # 162

Recreational Partnerships

• shows community collaboration in forming teams or holding

recreational events

Worksheet # Rec-4

Page # 163

Heritage

Museums

• preservation of historical items provides the community residents

with the opportunity to learn about the community’s past

Worksheet # Rec-5

Page # 164

Heritage Designations

• preservation of historical items provides the community residents

with the opportunity to learn about the community’s past

Worksheet # Rec-6

Page # 165

Rural Community Health and Well-Being: A Guide to Action

35

The Arts Tool

Cultural Events And Activities

• indicates the degree of cultural opportunities within the

community and the diversity of interests to the residents

Worksheet # Rec-7

Page # 166

Cultural Events Partnerships

• shows community collaboration for cultural activities Worksheet # Rec-8

Page # 167

Public Library

• access to public libraries provides low-cost reading, research, and

recreation opportunities

Worksheet # Rec-9

Page # 168

Rural Community Health and Well-Being: A Guide to Action

36

R

esidents o

f

rural communities said:

"It's so much more than facilities. It's leadership,

the people, and the things that make it count."

"People working together towards a common goal

f

or the bene

f

it o

f

the whole communit

y

.

"

"How do you describe rural? Being involved in

community events and organizations."

"Leadership comes from a variety of sources, not

j

ust the town council. Everything isn't a committee

of councils."

Community Processes Indicators

Leadership, opportunities for participation

in decision-making, volunteerism and

community spirit contribute to the health

and quality of life in rural communities.

Characteristics of leaders, the roles they

play and their abilities to lead and mentor

others in the community have far-

reaching impacts today and into the

future.

Planning Tool

Community Vision and Action Plans

• shows the presence of planning processes Worksheet # Cp-1

Page # 169

Leadership

Strategies for Leadership Development

• shows the degree to which organizations have formalized leadership

development/mentoring programs.

Worksheet # Cp-2

Page # 170

Elected Leadership Positions

• shows what elected leadership and the diversity that exists in the

community. Measuring voter turnout and number of offices filled

by acclamation may be indicators of active involvement or apathy

Worksheet # Cp-3

Page # 171

Volunteerism

Volunteer Organizations

• shows the extent of active volunteerism in the community Worksheet # Cp-4

Page # 172

Informal Volunteer Activities (such as snow clear, grass-cutting)

• shows the extent of active volunteerism in the community Worksheet # Cp-5

Page # 173

Religious Establishments

• shows the extent of organized religion in the community Worksheet # Cp-6

Page # 174

Registered Charities & Foundations

• indicates the presence of charitable organizations, and may indicate

the degree of competition for resources

Worksheet # Cp-7

Page # 175

Local Policies & By-laws

By-Law Enforcement Processes

• indicates enforcement and compliance with by-laws Worksheet # Cp-8

Page # 176

Rural Community Health and Well-Being: A Guide to Action

37

R

esidents o

f

rural communities said:

"I think people need to feel hopeful and optimistic.

You know we have a survival mindset. We tend to

s

top bein

g

cooperative and people

g

et ver

y

territorial…I think we are better off if we can live

together."

"I have found it very unique that when something

happens in your life, whether tragic or happy, you

have an influx of well-wishers and people to

s

upport

y

ou.

"

"Everybody knows everybody here. My dad got

diagnosed with lung cancer, and all the community

p

ulled to

g

ether and had a hu

g

e

f

undraiser

f

or them,

s

o the

y

are never

g

oin

g

to be stuck.

"

Social Supports Indicators

Support from families, friends and

communitiy is associated with better

health. The caring and respect that occurs

in social relationships, and the resulting

sense of satisfaction and well-being acts as

a buffer against stressors. Social stability,

recognition of diversity, good working

relationships, and cohesive communities

provide a supportive environment that

reduces or eliminates many potential risks

to good health. Investing in and building

the social capital of the community will

have a positive impact on the health and

well-being of the community.

Social Services Tool

Children In The Care Of Child And Family Services

• indicates potential need for social support programs and resources Worksheet # Soc-1

Page # 177

Licensed Child Day Care

• accessibility to child care allows the parents to contribute to the

economy outside the home. Availability and accessibility to

children’s day care may influence a child’s development.

Worksheet # Soc-2

Page # 178

Crisis-Intervention Support Systems

• shows the prevalence of support available within the community Worksheet # Soc-3

Page # 179

Adult Day Program

• shows the extent to which an adult support services are available Worksheet # Soc-4

Page # 180

Community Programs

Self-Help Groups And Community-Based Social Support

Programs

• shows the prevalence of mutual support available within the

community and indicates community awareness and support for

other community members

Worksheet # Soc-5

Page # 181

Children’s Organizations

• shows the extent to which organized programs for children are

available and their affordability

Worksheet # Soc-6

Page # 182

Youth Organizations

• shows the extent of youth programs that are available Worksheet # Soc-7

Page # 183

Seniors’ Organizations

• shows the extent of seniors’ programs that are available Worksheet # Soc-8

Page # 184

Parent And Child Groups

• shows the extent of social supports to parents and children Worksheet # Soc-9

Page # 185

Meal Programs

• shows the extent to which a meal program is utilized Worksheet # Soc-10

Page # 186

Rural Community Health and Well-Being: A Guide to Action

38

Health

Population

Social

Supports

Community

Processes

R

ecreation

Heritage

Arts

Community

Infrastructure

Environment

Education

Economics

Safety

&

Security

Assets &

Strengths

Stressors

Health &

Well-Being

Community

Resiliency

Stressors

Community Action

(Becoming)

Interactions as a

collective unit

(Being)

Stressors

Expression of

a sense

of community

(Belonging)

Chapter 4 - Community Action

John Everitt , Frances Racher and Marian Beattie

Community Health Action Model

Adapted from Kulig in Ramp et al 1999, and Vollman et al 2003

Collective and collaborative action empowers communities to take true ownership of the

health and development of their community and of every citizen, regardless of age, gender,

ethnicity, socio-economic status, residential tenure and community roles. By understanding

community resiliency (Community Resiliency Framework p.5) when gathering information

about the health and well-being of a community (Rural Community Health and Well-Being

Framework p.19) a more complete picture of the community will emerge. The Community

Health Action Model depicts this synergy, enabling communities to use a more holistic

approach. An illustration of this is found on the following page.

Chapter

4

Rural Community Health and Well-Being: A Guide to Action

39

Health

Population

Social

Supports

Community

Processes

R

ecreation

Heritage

Arts

Community

Infrastructure

Environment

Education

Economics

Safety

&

Security

Assets &

Strengths

Stressors

Health &

Well-Being

Community

Resiliency

Stressors

Community Action

(Becoming)

Interactions as a

collective unit

(Being)

Stressors

Expression of

a sense

of community

(Belonging)

Social Economic

Environment

Health

Population

Social

Supports

Community

Processes

R

ecreation

Heritage

Arts Community

I

nfrastructure

E

nvironmen

t

E

ducation

E

conomics

S

afety

&

S

ecurity

Bein

g

Belon

g

in

g

Becomin

g

=

The Community Health Action Model: A Model for Community Development and Action

Community Resiliency Framework Rural Community Health & Well-Being Framework Community Health Action Model

Stressor s

Health &

Well Being

Assets &

Strengths

Community

Resiliency

Stressor s

Community Action

(Becoming)

Interactions

collective unit

(Being)

Expression of

a sense

(Belonging)

+

Rural Community Health and Well-Being: A Guide to Action

40

“The one who listens does the most work, not the one who speaks".

(Covey, 1989)

Communication

Effective Listening

Communications experts estimate that only seven percent of our communication is

represented by the words we say, another thirty-eight percent by our sounds and how we say

words, and fifty-five percent by our nonverbal and body language. People communicate

beyond words to express feelings. Often they disclose these feelings through word emphasis

and body language, even though they may be verbally communicating conflicting ideas

(Covey, 1989).

The Listening Continuum (Covey, 1989)

5. Empathetic Listening Within the other’s frame of reference

4. Attentive Listening ]

]

3. Selective Listening ]

] Within one’s own frame of reference

2. Pretend Listening ]

]

1. Ignoring ]

An effective listener needs to develop an awareness of his or her communication filters and

barriers in order to develop more effective listening skills. These filters form an intimate part of

the person and can frequently cause barriers to the listening process. Common filters include:

attitudes; expectations; values; self-image; interests; past experiences; prejudices; memories;

beliefs; and assumptions.

Improving Listening Skills

• Be prepared to listen. If you have other priorities and time constraints, don’t pretend to

listen. Reschedule to a better time, or accept the need to listen and do it.

• Listen for total meaning and pay attention to both the verbal and non-verbal

communication.

• Listen in an understanding and supportive way. Use the whole body including eye contact

and facial expressions to convey attentiveness and feelings.

• Respect the speaker. Recognize your listening filters towards the person, and remove

them. Show respect by concentrating and not interrupting.

• Clarify your understanding of what was said by asking questions or paraphrasing what

was said and asking for confirmation.

Rural Community Health and Well-Being: A Guide to Action

41

Awareness of Interpersonal Relations – The Johari Window

The Johari Window was developed in 1955 to illustrate relationships in terms of awareness (Luft

1970).

Quadrant 1 Open refers to behaviours and motivations known to self and known to others.

Quadrant 2 Blind is where others see things in ourselves of which we are unaware.

Quadrant 3 Hidden represents things we know but do not reveal to others (e.g. hidden

agendas or matters about which we have sensitive feelings).

Quadrant 4 Unknown points to the area where neither the individual nor others are aware of

certain behaviours or motives. We can assume their existence because eventually these things

become known, and we then realize these unknown behaviours and motives were influencing

relationships all along.

The more people are able to expand Quadrant 1, the more open they will be toward forming

relationships with others.

Open

(Public)

Blind

Hidden

(Private)

Unknown

12

3 4

Known to Not Known to Self

Known to

Others

Not known to

others

Rural Community Health and Well-Being: A Guide to Action

42

Leadership

We all have leadership potential. Leadership is a mix of knowledge, values, skills, and

behaviours. Leaders often stimulate others to think broadly. They communicate vision and

purpose, and spend time building relationships within the group.

Leadership Styles

Telling/Directing -- Group members are unwilling and unable.

• This style may be appropriate when the members are new or inexperienced and need a lot

of help.

• The leader provides structure and guidance to the group.

• The leader defines the roles and directs the group on what, how, when and where to do

various tasks.

Selling/Coaching – Group members are willing, but unable.

• This style is appropriate when the group has more experience.

• The leader’s role is to assist the group members in doing tasks for which they do not have

the skills.

• Direction and guidance are necessary, but the leader provides encouragement and

inspiration to maintain the willingness of the group.

Participating/Supporting – Group members are unwilling but able.

• The group members have the ability to do the task, however they may be apprehensive to

start or complete the task.

• The group members and leader participate in making decisions and carrying them out

together.

• The leader puts more emphasis on relationships building within the group.

• The leader is a resource person and helper.

Delegating/Trusting – Group members are willing and able.

• The group members are both willing and able to take responsibility for directing their

own behaviour.

• The leader trusts the group to do their own thing and observes from a distance.

Leadership is a process that helps get things done…It does not happen when

someone is nominated to be the chairperson…Only when action takes place in a

community or organization has leadership occurred.

(

Marcou

,

1988

)

Rural Community Health and Well-Being: A Guide to Action

43

Page 205-206

Leader Skills

Know your organization:

• know the organization’s business;

• know how to run a meeting; and

• understand parliamentary procedure.

Know how to use effective communication skills:

• understand and use many communication methods; and

• use active listening skills.

Understand yourself:

• identify and clarify your values;

• assess your degree of self-confidence; and

• understand and relate to people with varying backgrounds and perspectives.

Understand leadership:

• understand and use appropriate leadership styles;

• challenge others;

• lead by example;

• encourage and empower group members; and

• celebrate small and large gains.

Know how to facilitate learning:

• establish goals and expectations for the group;

• evaluate progress and results of projects and processes; and

• help others to learn skills necessary to work in a group.

Know how to form and work in groups:

• understand group dynamics;

• facilitate goal and priorities setting;

• involve group members in the decision-making process;

• identify and delegate responsibilities;

• identify and resolve conflicts; and

• understand change and people’s reaction to change.

Rural Community Health and Well-Being: A Guide to Action

44

A partnership is an agreement to combine resources, ideas and talents to do somethin

g

together that will benefit all involved.

People make partnerships and people make them work,

not agencies and organizations!

Partnerships

A partnership is a relationship where two or more parties, having compatible goals, form an

agreement to share the work, the risk and the results or proceeds. It adds value to each partner’s

respective service, product or situation. There is give and take with shared decision-making, risks,

resources, investment, power, benefits, burdens and accountability.

There are many benefits of working together, including

• increased community ownership;

• increased efficiency and effectiveness in the use of resources;

• development of strengths through diversity;

• coordination of activities; and

• a united front – acting together.

Partnerships Principles

• If you are the “new kid on the block”, you can’t force yourself on the existing players.

• Self-interest is not sufficient.

• Spell out what the community interest is and how the activity can help the different

partners meet a common set of objectives.

• Make sure that everyone agrees upon roles and how costs, benefits, and risks are to be

shared.

• Avoid inflexible starting positions.

• Small-scale projects can be a way of initiating a relationship.

• There must be a joint effort between the partners.

• Be prepared to assess whether the initial expectations have become unrealistic. Bring in

new partners if needed.

Rural Community Health and Well-Being: A Guide to Action

45

Revision & Closure

Evaluation

Resources

Communication

Roles & Responsibilities

Action Plan

Commitment

Members

Goals

Pathway to Effective Partnerships

Start with a common picture of the future.

Define the desired outcomes.

Include those who are involved.

Agree to work together.

Plan the steps required to reach goals.

Decide who does what.

Decide how information is shared.

Determine what’s needed and what’s available.

Decide what success is.

Adjust and move on.

Vision

Rural Community Health and Well-Being: A Guide to Action

46

Page 207–210

Success Factors

• Common vision and goals.

• A plan.

• Leadership.

• Community and political support.

• Resources.

• Help from the outside – when needed.

• Effective communication.

• Flexibility – compromise.

• Participation – many different groups.

• Willingness to work with change.

Partnership Actions

• Decentralize decision-making.

• Recognize and foster initiative.

• Encourage enlightened leadership.

• Accept varying and differing opinions and perspectives.

• Maintain effective communication skills of individuals and organizations.

• Have a willingness and ability to identify common ground.

• Have a realistic and shared vision.

• Have open planning.

• Have representation of different community interests.

• Have active sharing of the responsibility and the credit.

• Encourage the ability of individuals to distinguish between personal and organizational

interests, and interests of the community.

• Try to include representatives from all possible groups.

• Look for skills, not names.

• Try involvement by degree.

• Appeal to self-interest and identify the opportunity to contribute to the community.

• Use a wide-angle lens.

• Delegate a task and define it well.

• Use current leaders to recruit new leaders.

• Build a reputation for using people’s time well.

• Offer membership premiums.

• Raise the profile of the community partnership.

• Ensure that the community partnership maintains a positive image and high profile in the

community.

• Recruit well-known respected people in the community, but do not stop with them.

Rural Community Health and Well-Being: A Guide to Action

47

Partnership Pitfalls

• Lack of commitment.

• Confusion about the planning process and objectives.

• Lack of historical social ties and cohesion.

• No shared vision.

• “Analysis paralysis”.

• Temptation to start projects before planning.

• Efforts cease when the plan is completed.

• No credibility with the general public.

• Lack of community leadership.

• Missing sectors, interests, and organizations.

• Ineffective meetings.

• Bogged down by interpersonal conflict and confusion.

• Lack of rules for communications and decision-making.

Team Development

Stages of Development

A high-performing group does not just happen. It goes through stages of development.

Understanding those development stages helps the group move to a higher performance level

sooner.

Forming

• The group is getting started and organized.

• The group is a collection of individuals, not a cohesive group. Participants are learning

about each other.

• Group roles, processes, and ground rules need to be established.

Storming

• There is a sense of confusion. There may be intra-group conflict.

• Group members may feel that they are “going in circles” accomplishing little.

• Clarifying roles and processes will help move the group out of this stage.

Norming

• The collection of individuals has become a cohesive team.

• Group roles and processes are functioning well.

Performing

• The group is fully functional and capable of accomplishing the goals and objectives.

Rural Community Health and Well-Being: A Guide to Action

48

Page 211-212

Group Factors

Participation

• Who are the high and low participators?

Influence

• Is there a struggle for leadership?

• What effects does it have on other group members?

Decision-Making Procedures

• Does the group stay on topic or do they drift from topic to topic?

• Is there an attempt to get all members participating in a decision?

• What effect does this seem to have on the group?

Task Functions

• Does anyone ask for suggestions as to the best way to proceed or how to handle a

problem?

Membership

• Are there subgroups? Sometimes two or three members may consistently agree and

support each other, or consistently disagree and oppose one another.

Feelings

• What signs of feelings are evident in the group: anger, irritation, frustration, warmth,

affection, excitement, boredom, defensiveness, and competitiveness?

Norms

• Are only positive feelings expressed?

• Do members agree with other too readily?

• What happens when members disagree?

Group Vision and Strategies

Strategic visioning involves looking at where you are now, making decisions about where you

would like to be within a certain period and the creating steps for getting there. Involving your

group in a visioning process as part of the development will give your group a sense of purpose

and direction; help build your group into a team; help group members learn about each other’s

ideas and skills; give your group credibility; reveal strengths and limitations; and determine the

best use of resources.

This involves determining and analyzing what your group is and how it is functioning;

developing a mission statement; determining priorities; setting long term goals; setting short

term objectives; and producing a workplan.

Rural Community Health and Well-Being: A Guide to Action

49

Consensus

Consensus is a decision making process which best reflects the thinking of

all group members. Each individual should be able to find the

decision acceptable and can support it.

Attitudes for Consensus

Move From To

Competition Cooperation

Distrust Mutual trust

Personal ownership Common ownership

Suppressing feelings to avoid

conflict Valuing discussion and

disagreement

Relying on authority Equalizing power

Valuing the input of a few Valuing the contributions of all

Conditions for Consensus

• Unity of purpose.

• Equal access to power.

• Autonomy from external hierarchical structures.

• Time.

• Willingness to attend to process.

• Willingness to attend to attitudes.

• Willingness to learn and practice skills.

Guidelines for Achieving Consensus

• Avoid arguing your own position. Present your position, but listen to other member’s

reactions and consider them carefully.

• Do not assume that someone must win and someone must lose if the discussion reaches a

stalemate. Instead, look for the next most acceptable alternative for all parties.

• Do not change your mind simply to avoid conflict and reach agreement and harmony. When

agreement seems to come too quickly and easily, be suspicious.

• Explore all the reasons and be sure everyone accepts the solution for basically similar or

complementary reasons. Yield only to positions that have objective and logically sound

foundations. Avoid conflict-reducing techniques such as majority vote, averages, coin

Rural Community Health and Well-Being: A Guide to Action

50

flips, or bargaining. When a dissenting member finally agrees, don’t feel that he or she must

be rewarded by having his or her own way at some later point.

• Differences of opinion are natural and expected. Seek them out and try to involve everyone

in the decision process.

• Disagreements can help the group’s decision because with a wide range of information

and opinions, there is a greater chance that the group will come up with more adequate

solutions.

• Use observation to check for agreement. Use eye contact and watch group members’

body language for clues as to whether they agree or not.

Steps for Achieving Consensus

• Develop criteria that the solution needs to meet before the group discusses solutions, so

they will know how to interpret the information. Keep the criteria visible – on a flip chart

or poster.

• Share information. Conduct a round-robin discussion and solicit ideas from each

member. This gathers input from all members. Record the suggested ideas.

• Learn and listen. Individuals may ask for clarification of solution suggestions. This is

not a time for debate or argument, simply to clarify.

• Analyze alternatives. Gather information on the strengths and weaknesses of all proposed

ideas, as well as how hard or easy they will be to implement. Analyze the similarities and

differences among alternatives. Any known data/facts can be incorporated into the key

points.

• Think creatively. Look for ways to combine parts of different ideas

• Decide. Consensus does not mean that everyone is necessarily happy with the decision.

It does mean that all group members feel they can support the decision, even if it is not

their first choice. Allow people time to carefully consider the pro’s and con’s of the

various alternatives and to check with others outside the group, if necessary.

Problem Solving

Problem solving is something we do all the time. Some problems are small and solutions evolve

automatically. Other problems are more complicated and require extra time and effort to come up

with an appropriate solution.

Identify, Analyze and Clarify the Problem

• Involve all stakeholders.

• How/when did the problem originate?

• Who is involved with this problem and how?

• How does this problem affect our organization?

• What other problems are related to this situation?

• What would you like to see changed?

• Who has the power to make changes?

Rural Community Health and Well-Being: A Guide to Action

51

Page 213-214

• What do we have going for us in the organization that will help make changes to this

situation?

• What do we have going on in the organization that may sabotage us in making changes?

Generate Possible Solutions

• Within the group, brainstorm as many solutions as possible.

• Do not editorialize or comment on the suggestions.

• Write down all the possible solutions on a flipchart or board for all to see.

• Encourage group members to think “outside the box” or beyond their conventional ways.

Select the Best Solution

• Use a Solutions Matrix.

• Analyze each solution suggestion according to predetermined criteria.

• Once the Solutions Matrix is completed, pick the best solution that is

closest to your solution requirements.

Plan and Implement the Solution

• Write down the steps to be taken.

• Number the steps in the order they need to be done.

• Add to each step:

• why the step is important;

• what needs to be done;

• where should it be done;

• who is responsible;

• when will the task need to be completed; and

• how the step will be completed.

Evaluate the Results

• Have you accomplished your goal?

• Do you need to try something else?

• What could you have done differently?

Conflict Management

Conflict is something that groups can count on. It can be a positive element for the group.

Without it, people would not be challenged to think beyond their everyday routine

boundaries. Conflict can also be negative and adversely affect the group. Rather than trying

to avoid it, look at conflict as an opportunity for the group to become a productive team. It is

important that conflict be recognized, accepted and worked out. If conflict is ignored, group

members may stop participating, or even leave the group. Conflict evolves through stages,

involves an observable process, and has a number of common characteristics. Recognizing

and understanding what may be happening is the first step to resolving the situation

effectively.

Rural Community Health and Well-Being: A Guide to Action

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Page 215

Stages

Differences – Tension development

There are different points of view, values, and goals. Tensions are starting to develop.

Signs include:

• people are spending more time telling than asking and listening; and

• people are not as tolerant of others’ differences as they once were.

Discord – Role dilemma

People are starting to look out for individual interests. They are trying to decide if they

should take sides, and if so, which one. A win-lose starts to build up.

Signs include:

• people are less willing to communicate in a solutions-oriented manner;

• people are starting to become defensive about their ideas and start to take sides;

• problems are itemized and people start to justify their positions; and

• people are starting to think of ways to win.

Dispute – Confrontation

People meet head on and clash. If both parties hold fast to their side, the showdown may

cause permanent barriers. People engage in pettiness, confrontations, hostility, silent

resignation, and even sabotage.

Signs include:

• people are more concerned about winning than making the best decisions; and

• common goals give way to personal goals.

Conflict Resolution

• Dig for and reach the compatible interests. Underneath incompatible

positions lie compatible interests.

• Listen to both sides equally, and hear the valuable contributions. Every

side usually has something valuable to say.

• Initiate discussion a dialogue, encouraging participation. Issues become polarized when

there is little or no dialogue.

• Create an environment where people can express their feelings and concerns. High

emotions charge the issue.

• Ask them to identify areas they have in common, remind them, and expect progress.

People will focus on differences.

• Search for solutions: seek to understand but remind them of the need to move on. People

may become defensive and protect, justify or explain their position.

• People will immediately want to discuss their individual needs. Only when good-will has

been established, should needs be discussed.

• Listen to each person’s needs, and ensure each person listens to each other.People often

feel their story has not been heard.

• Step back and ask the people what they want the outcome to be, and list the desired

outcomes. Identifying and understanding the desired outcomes will result in progress.

• Identify and understand the emotions, and move the discussion to approaches, strategies

and desired outcomes. Conflict creates emotions and feelings that are barriers to progress.

Rural Community Health and Well-Being: A Guide to Action

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Page 216-219

Effective Meetings

A properly run meeting is one of the best ways for people to exchange information,

generate ideas, and check their understanding of the issues.

Good meetings are planned and managed.

• Plan the meeting.

• Plan to have food/refreshments at the meeting. Food can be used

to enhance the cohesiveness of the group. The type of

food/refreshments will depend on the time of day, the meeting’s

purpose and the group’s resources. It can range from light

refreshments such as coffee and cookies, to a meal.

• Present the agenda.

• Obtain agreement on agenda items.

• Summarize each major decision or action.

• Summarize the meeting outcomes.

• Clarify the next steps:

• assignments (use an Action Plan form);

• solicit agenda items for the next meeting; and

• choose date, time and place for next meeting.

• Evaluate the meeting,

Roles

• Organizer/Coordinator

• Chairperson/Leader/Facilitator

• Recorder/Minute taker

Purpose

The meeting’s purpose is a critical element to getting and keeping the group on track. The

purpose guides the group’s actions, is clear, understandable and brief.

Agenda

An agenda is a step-by- step outline of the points that need to be covered at a meeting. It is

the meeting tool that keeps the meeting on task and on time.

• Ask for input.

• Establish a “cut-off” date for items to be added to the agenda.

• Distribute the agenda in advance so participants can prepare for the meeting.

• Put agenda items in such an order that the most important tasks are dealt with first.

Rural Community Health and Well-Being: A Guide to Action

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Page 220

Support Materials

If written reports and materials are needed for a productive meeting, ensure that they are prepared,

copied and distributed prior to the meeting so people can review them ahead of time and be

prepared for discussion at the meeting.

Minutes

Minutes provide a permanent record of the proceedings of the meeting,

keep track of progress and inform absent members.

A basic set of minutes include:

• the name of the group;

• when and where the group met;

• who was present (or absent);

• who chaired the meeting;

• adoption of the last meeting’s minutes;

• the matters discussed and any decisions that were made;

• business matters;

• old business refers to items from previous meetings,

• new business refers to items that have not been addressed before,

• when recording items of business, the motion, who made the motion, the seconder,

and whether it was carried or defeated should be included;

• agenda items for the next meeting;

• the time and place for the next meeting; and

• the recorder and chairperson’s names.

Rural Community Health and Well-Being: A Guide to Action

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Page 221

Page 222

Planning for Action

Determine Priorities

Decide what needs, issues or problems should get the most attention. Assess what you can

accomplish, what barriers you may face and your chances of success when trying various

activities.

Set Goals

Goals are general statements describing what it is that you hope to

accomplish. They are simple broad statements reflecting your group’s

priorities. Goals should include what you hope to accomplish over the

duration of your project.

Set Objectives

Objectives operationalize the goals and are the specific, measurable results that you wish to

achieve. They are linked to a defined short-term time period. They must be closely related

to your goals so that once the objectives have been reached, you know your goal has been

reached as well.

Objectives:

• contain an action verb;

• are directly related to your goals; and

• have a specific date or time frame for results to be achieved.

Effective objectives are SMART:

Specific

Measurable

Attainable

Realistic

Time-bound

Create a Workplan

The workplan is a blueprint for action that identifies what you hope to achieve,

how you intend to make it happen, when you are going to do it, who will do it

and/ makes sure it gets done, and how and when you will measure your results.

A workplan specifies:

• the tasks that need to be completed to reach the objectives;

• the order for undertaking tasks;

• the time frame for completing the tasks with milestones for specific events or activities;

• the resources need to reach the objectives, including people, materials, facilities

• and funds; and

• the group members who are responsible for completing the individual tasks.

Rural Community Health and Well-Being: A Guide to Action

56

Use a Logic Model

A logic model is a plan for developing a project, process or action, as well as a plan for

evaluating that project, process or action. In the development phase, the flow is from left to

right; in the evaluation phase, the flow is right to left.

Logic Model Components

Goals

Goals are statements of what you are trying to accomplish. These are broad, general

statements of what an organization is trying to do.

Objectives

Objectives are specific statements of what you want to do. They are time-limited and part of

what a project hopes to accomplish.

Activities

Activities or services are the actions you will undertake to accomplish each objective.

Activities are actions that produce a good or service (output).

Outputs

Outputs are actual services or products produced and delivered by the project to an intended

target audience (e.g. health information, policies, research). These also include the one-time

products that result from a project (e.g. a training manual). Outputs are directly controlled by

the project.

Outcomes

Outcomes are the changes, improvements and benefits that occur as a result of the project’s

activities and outputs. They should be logically related to the objectives. e.g. increased

knowledge about breast self-examination and breast cancer treatment options. The

outcomes can be broken further down into:

• Immediate Outcomes: Areas where you have direct influence over the achievement of

these outcomes.

• Intermediate Outcomes: These changes occur after the immediate outcomes. These are

areas where your program has indirect influence over the achievement of outcomes.

• Long-term Outcomes Ultimate impact or effect of a program. These are areas where

your program has indirect influence over the achievements of these outcomes.

Indicators

Indicators are evidence, proof or information needed to show progress and the attainment of

your desired outcomes. Indicators should be reasonable, useful and meaningful evidence of

the intended outcome. They can be quantitative or qualitative.

Rural Community Health and Well-Being: A Guide to Action

57

What you are

trying to

accomplish

Goal

What you are

trying to

accomplish

Goal

Objective

What you

want to do

Objective

What you

want to do

Activity

Actions

Activity

Actions

Output

Services or

products

Output

Services or

products

Output

Services or

products

Indicators

Evidence, proof or

information

showing progress

& attainment of

Outcomes

Quantitative

Qualitative

Indicators

Evidence, proof or

information

showing progress

& attainment of

Outcomes

Quantitative

Qualitative

Intermediate

Outcomes

Intermediate

Outcomes

Immediate

Outcomes

Immediate

Outcomes

Long Term

Outcomes

Long Term

Outcomes

Change,

improvement or

benefit

anticipated

unanticipated

anticipated

Intermediate

Outcomes

Intermediate

Outcomes

Immediate

Outcomes

Immediate

Outcomes

Long Term

Outcomes

Long Term

Outcomes

Change,

improvement or

benefit

anticipated

unanticipated

anticipated

Intermediate

Outcomes

Intermediate

Outcomes

Immediate

Outcomes

Immediate

Outcomes

Long Term

Outcomes

Long Term

Outcomes

Change,

improvement or

benefit

anticipated

unanticipated

anticipated

Development

Evaluation

Logic Model

Rural Community Health and Well-Being: A Guide to Action

58

Evaluation

Effective evaluation can account for what has been accomplished throughout a process,

project or program, promote learning about what strategies worked and didn’t work,

provide feedback to inform decision-makers at all levels, and contribute to the body of

knowledge about community development. (Health Canada, 1996). Evaluating progress

involves looking at the results of the efforts and assessing whether goals and objectives

have been met. Evaluation takes time, effort and resources, but needs not to be onerous.

An Evaluation considers (Health Canada, 1996):

• Did we do what we said we would do?

• What did we learn about what worked and what didn’t work?

• What difference did it make that we did this work?

• What knowledge, attitudes, skills and behaviour changed?

• What changed ?

• Were there unexpected changes?

• What evidence is there to attribute to the changes?

• Were other initiatives started?

• What new partnerships developed?

• What could be done differently?

• How can we use the evaluation findings for continuous learning?

Participatory Evaluation

Participatory evaluation is a collaborative approach that builds on people’s strengths and

values the contribution of everyone involved, focusing on learning, success and action.

The evaluation process is ongoing and includes ways to enable all community residents

to use the information from the evaluation. The nature of participatory evaluation is that

everyone involved contributes to the evaluation.

Evaluation Process

Set the Evaluation Context

• Who are you?

• Why are you doing an Evaluation?

• For whom is the Evaluation?

• What will you evaluate?

• How will you evaluate?

• Who will conduct the Evaluation?

Prepare the Evaluation Plan

• What are the goals and objectives?

• What are the Evaluation questions?

• What method will you use?

• What is the timetable?

context

Prepare

the

p

lan

Use

the

results

Gather

the

information

Make

sense

of the

information

Set

the

Rural Community Health and Well-Being: A Guide to Action

59

Gather Information

• What existing information do you have?

• What new information do you need to gather?

• What tools do you have?

• What tools do you need to develop/obtain?

Making Sense of the Information

• Who and how will you compile the information?

• Who and how will you analyze the information?

• What conclusions can you draw from the information?

Use the Results

• What recommendations are forthcoming?

• How will these recommendations be presented? In a report?

Who will write the report?

• How will you disseminate the results?

• What action(s) will you take?

Evaluation Types

Outcome

• one-time effort.

• summarizes results.

• looks at outcomes.

• Did you reach your Goal and Objectives?

Process

• on-going.

• can be informal.

• looks at processes.

• What aspects are working well? Why?

• What aspects can be improved? How?

A Participatory, Qualitative Approach to Evaluations

• Form an advisory committee at the beginning of the project with various stakeholders

represented.

• Ensure that the goals, objectives, activities, outputs are understood by all members.

• Brainstorm the anticipated outcomes and the indicators that you might look for when

the project is complete.

• Discuss an evaluation strategy:

• •What do we want to know?

• Why do we want to know it?

• Who is it intended for?

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Page 223-227

• Discuss ways you can collect information along the way (process evaluation) and the

ways that they can contribute to that.

• Evaluate the end of the project (outcome evaluation)

Evaluation Questions

• Did we do what we say we would do? (activities and outputs). “What”

• Did the activities have the desired outcomes? “What”

• What did we learn about what worked and what didn’t work? (outcomes and

indicators) “Why”

• What difference did it make that we did this work? (analysis of outcomes and

indicators) “So What”

• What could we do differently? (analysis of outcomes and indicators) “Now What”

• How do we plan to use the evaluation findings for continuous learning? (reflection—

feedback into goals and objectives) “Then What”

Evaluation Tools and methods

• Written survey questionnaire

• Satisfaction sheets

• Face-to- face interview

• Focus groups

• Telephone interviews

• Project records/documentation

• Participant observation

• Culturally sensitive approaches

Tips for Designing Effective Evaluation Tools

• Develop evaluation tools in collaboration with the people who will

use them.

• Ask only for information that will be used.

• Keep them short and simple.

• Use plain language with no jargon.

• For tools requiring written responses:

• Use large print.

• Avoid clutter.

• Leave lots of white space.

• Provide ample room for responses.

Rural Community Health and Well-Being: A Guide to Action 61

Chapter 5 - Tools for Action

Robert Annis, Ryan Gibson, Marian Beattie, Devron Kobluk, Katherine Pachkowski and Nicole Shirray

Collecting and analyzing information in a community may seem like a daunting task. To

assist in this task, the following is a series of reproducible worksheets and charts to help

organize and present information. Throughout Chapters 2-4, reference has been made to

various worksheets or tools that are located in this chapter.

For each of the indicators of the framework categories, ‘petals’, a worksheet has been

developed. Each worksheet, where appropriate, provides the relevance of the indicator, the

source of the information and a calculation formula. When available, information on the

indicator at the provincial level has been populated. Provincial information is valuable in

making comparisons to the information collected locally. At the bottom of each worksheet

three questions are posed; What does the information mean? What are the implications? and

What should the follow up be? These questions assist in moving the information collected

and analyzed to action (see Chapter 4, Community Action).

Often the information source stated is as an initial contact. You may have to search out the

specific information required from the general source, such as Statistics Canada. For

assistance in seeking out specific information, please refer to Chapter 2 (Information

Collection and Analysis) and the Reference section.

As each community is different, you may find that a modification of the indicator or the

source of information is required. These indicators are provided as an initial start and can be

modified to best suit your community.

Chapter

5

Rural Community Health and Well-Being: A Guide to Action 62

Population Indicators Worksheets

Pop-1 Population By Five Year Age Group

Framework Section Population

Indicator Population By Five Year Age Group

Relevance Data on age structures and gender are useful in determining need

for and allocation of resources for education, day care, health care,

and many other social services.

Information Source Statistics Canada

Calculation Formula

%100

_

__5___ =x

populationTotal

groupageyrselectofPopulation

Calculation

Table Pop-1: Population of Manitoba, 1996 & 2001

Community Manitoba*

Age 1996 % 2001 % 1996 % 2001 %

Total 1,113,898 100 1,119,580 100

0-4 80,720 7.2 70,670 6.3

5-14 163,895 14.7 163,045 14.6

15-19 77,675 7 80,425 7.2

20-24 76,115 6.8 72,850 6.5

*Source: Statistics Canada 1996 & 2001

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 63

Pop-2 Population by Gender Group (Male/Female)

Framework Section Population

Indicator Population By Gender Group (Male/Female)

Relevance Data on age structures and gender are useful in determining need

for and allocation of resources for education, day care, health

care, and many other social services.

Information Source Statistics Canada

Calculation Formula

%100

_____

___ =x

periodsametheforpopulationTotal

groupgenderofPopulation

Calculation

Table Pop-2: Population of Manitoba, by age group and gender, 2001

Community Manitoba*

Age Male % Female % Male % Female %

Total 549,600 100 569,985 100

Children

(1-14) 119,710 21.8 114,000 20

Youth

(15-24) 77,655 14.1 75,620 13.3

Adults

(25-64) 286,230 52.1 289,955 50.9

Seniors

(65+) 66,000 12 90,405 15.9

*Source: Statistics Canada, 2001

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 64

Pop-3 Migrant Population

Framework Section Population

Indicator Migrant Population

Relevance Indicates the mobility among residents and may be a sign of

economic or social gain/loss in a community that could be

investigated to understand causes and identify strategies for

action.

Information Source Statistics Canada

Calculation Formula %100

_____

__ =x

periodsametheforpopulationTotal

populationmigrantSelect

Calculation

Table Pop-3: Mobility Status of Manitoba Residents in 2001,

Compared To Previous Year

Community Manitoba*

Mobility # % # %

Total Population (1 year and

older) 1,090,115 100

Non-movers (lived at same

address 1 years ago) 942,240 86

Movers 147,880 14

From within Manitoba 127,040 12

From outside of Manitoba 20,840 2

*Source: Statistics Canada, 2001

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 65

Pop-4 Home Language

Framework Section Population

Indicator Home Language

Relevance May indicate a need for services in languages other than

English.

Information Source Statistics Canada

Calculation Formula %100

_

___ =x

populationTotal

languageselectspeakingPopulation

Calculation

Table Pop-4: Home Languages for Manitoba, 2001

Community Manitoba*

Home Language # % # %

Total population 1,119,583 100

Single responses 955,305 85

English 902,630 81

French 8,965 0.80

Non-official languages 43,710 4

German 8,595 0.77

Cree 4,570 0.41

Tagalog (Philipino) 4,370 0.39

Chinese, n.o.s. 2,390 0.21

Punjabi 2,250 0.20

Other languages 21,540 2

Multiple responses 148,395 13

English and French 28,352 3

English and non-official language 117,555 11

French and non-official language 525 0.05

English, French and non-official

language 1,985 0.18

*Source: Statistics Canada, 2001

What does the information mean? What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 66

Pop-5 Ethnicity

Framework Section Population

Indicator Ethnicity

Relevance Indicates ethnic composition and community diversity.

Information Source

Statistics Canada

Calculation Formula

%100

_

___ =x

populationTotal

ethnicityselectofPopulation

Calculation

Table Pop-5: Ethnic Origin for Manitoba, 2001

Community Manitoba*

Home Language # % # %

Total population 1,119,583 100

English 243,835 22

Canadian 252,330 23

German 200,370 18

Scottish 195,570 17

Ukrainian 157,655 14

French 139,145 12

Irish 143,950 13

Aboriginal Origins 166,590 15

Polish 73,885 7

Filipino 31,645 3

*Source: Statistics Canada, 2001

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 67

Pop-6 Education Attainment Level

Framework Section Population

Indicator Education Attainment Level

Relevance This indicator can be used to compare graduation rates over time.

Education attainment levels correlate with socio-economic status.

Information Source

Statistics Canada

Calculation Formula

%100

__20__

_____ =

+x

oldyearspopulationTotal

levelattainmenteducationselectofPopulation

Calculation

Table Pop-6: Population By Educational Attainment Level For Manitoba, 2001

Community Manitoba*

Educational

Attainment Level # % # %

Total Population 20+ 789,615 100

Less than Grade 9 86,805 11

Some grade 10-12 185,090 23

High school diploma 89,725 11

Some college 44,715 6

College or trades certificate or

diploma 205,415 26

Some university (no degree) 64,710 8

Undergraduate or post graduate

degree 113,150 14

*Source: Statistics Canada, 2001

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 68

Pop-7 Population Growth/Loss

Framework Section Population

Indicator Population Growth/Loss

Relevance Indicates demographic change in a population.

Information Source

Statistics Canada

Calculation Formula

%100

______

**2_*1_ =

−

x

periodtimeofendatpopulationTotal

TpopulationTPopulation

*T1-Population at end of time period

**T2- Population at beginning of time period

(Determine the period of time to be examined using census years. A

negative result indicates a population loss over the examination period.)

Calculation

Table Pop-7: Population Growth Rate for Manitoba, 1996 to 2001

Community Manitoba*

Population, 1996 1,113,898

Population, 2001 1,119,580

Difference between Populations +5,682

Population Growth/Loss +0.5%

*Source: Statistics Canada, 1996 & 2001

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 69

Pop-8 People Living Alone

Framework Section Population

Indicator People Living Alone

Relevance May be used as an indirect measurement of social isolation

which may imply deprivation of social relations.

Information Source

Statistics Canada

Calculation Formula %100

_

____ =x

populationTotal

alonelivingpeopleofNumber

Calculation

Table Pop-8: People living alone in Manitoba, 2001

Community Manitoba*

# % # %

Total population 1,119,583 100

Number of people living alone 121,755 11

*Source: Statistics Canada, 2001

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 70

Pop-9 Census Families

Framework Section Population

Indicator Census Families

Relevance Represents the composition of the community by family

status.

Information Source Statistics Canada

Calculation Formula %100

_

_____ =x

populationTotal

typesfamilycensusselectofPopulation

Calculation

Table Pop-9: Census Families Manitoba, 2001

Community Manitoba*

Census Family Types # % # %

Total population 302,855 100

Total couple families 253,690 84

Total family of married couples 224,055 74

Without children at home 94,870 31

With children at home 129,185 43.

1 Child 43,810 14

2 children 54,170 18

3 or more children 31,210 10

Total families of common-law couples 29,635 10

Without children at home 16,315 5

With children at home 13,320 4

1 child 6,120 2

2 children 4,290 1

3 or more children 2,910 0.9

Total lone parent families 49,160 16

Female parent 40,100 13

1 child 23,525 8

2 children 10,970 4

3 or more children 5,605 2

Male parent 9,065 3

1 child 5,840 2

2 children 2,295 0.7

3 or more children 925 0.3

*Source: Statistics Canada, 2001 lines388-405

What does the information mean? What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 71

Pop-10 Population By Marital Status

Framework Section Population

Indicator Population By Marital Status

Relevance Represents the composition of the community by marital

status.

Information Source Statistics Canada

Calculation Formula

%100

_

____ =x

populationTotal

statusmaritalselectofPopulation

Calculation

Table Pop-10: Percentage of Single Parent Families With Children for Manitoba, 2001

Community Manitoba*

# % # %

Total population 15 years and

over by legal marital status 885,865 100

Never married (single) 218,540 27

Legally married (not separated) 458,435 52

Separated, but still legally married 24,915 4

Divorced 57,130 6

Widowed 63,845 7

* Source: Statistics Canada, 2001

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 72

Pop-11 Labour Force Replacement Ratio

Framework Section Population

Indicator Labour Force Replacement Ratio

Relevance Is useful in predicting the future available labour force. If

the number is greater than 1 there is a surplus of potential

labour.

Information Source

Statistics Canada

Calculation Formula

LFR

agedpeopleofNumber

agedchildrenofNumber =

−

6545____

150____

Calculation

Table Pop-11: Labour Force Replacement for Manitoba, 2001

Community Manitoba*

Number of children aged 0-15 233,715

Number of people aged 45-64 255,865

Labour force replacement ratio 0.91

*Source: Statistics Canada, 2001

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 73

Pop-12 Population Dependency Ratio

Framework

Section Population

Indicator Population Dependency Ratio

Relevance Indicates the economic responsibility of the working age population for

those that are not working.

Information

Source Statistics Canada

Calculation

Formula

ratio

agedpopulation

agedpopulationagedpopulation =

−

+

−

6415___%

)65___(%)140___(%

Calculation

Table Pop-12: Population Dependency for Manitoba, 2001

Community Manitoba

# % # %

Total population 1,119,583 100

Number of children aged 0-14 233,715 21

Number of people aged 15-64 729,445 65

Number of people 65+ 156,420 14

Population dependency ratio 0.54

*Source: Statistics Canada, 2001

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 74

Health Indicators Worksheets

H-1 Self-Perceived Health

Framework Section Health

Relevance Perception of health may be an overall indicator of health

status.

Information Source

Statistics Canada

Canadian Community Health Survey (CCHS)

Local

Calculation Formula

%100

__

_Re =x

sizesampleTotal

answerspondents

Calculation

Table H-1: Self-Perceived Health, 2003

(In general, would you say your health is excellent, very good, good, fair or poor?)

Community Manitoba*

Self-Perceived Heath # % # %

Excellent 29,953 22

Very good 46,442 35

Good 36,037 28

Fair 13,715 10

Poor 4,574 4

Don’t know 38 0.05

Total sample size 130,880 100

*Source: Canadian Community Health Survey (Statistics Canada), 2003

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 75

H-2 Community Health Promotion Events and Activities during a 1-Year Period

Framework Section Health

Indicator

Community Health Promotion Events and Activities

during a 1-Year Period

Relevance May indicate the extent of health education programs

available in the community.

Information Source

Local

Calculation Formula

%100

___#

___# =x

activitieseventsTotal

activiteseventsSpecific

Calculation

Table H-2: Community Health Promotion Events and Activities during a 1-Year Period

Event/Activity # of Events/Activities % Total

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 76

H-3 Collaborative Partnerships with Other Communities for Health Promotion

Events

Framework Section Health

Indicator

Collaborative Partnerships with Other Communities for

Health Promotion Events

Relevance Shows the amount of community collaboration for health

promotion.

Information Source

Local

Calculation Formula

%100

___#

___# =x

pspartnershiofTotal

pspartnershiofSpecific

Calculation

Table H-3: Collaborative Partnerships with Other Communities for Health Promotion

Events

Partnerships # of Partnerships % Total

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 77

H-4 Self - Perceived Health Care Needs

Framework Section Health

Indicator Self - Perceived Health Care Needs

Relevance This indicates residents’ perceptions of the health care

needs in their community.

Information Source

Statistics Canada

Canadian Community Health Survey (CCHS)

Local

Calculation Formula

%100

__

_Re =x

sizesampleTotal

answerspondents

Calculation

Table H-4: Presence of Self-Perceived Unmet Health Care Needs, 2003

(During the past 12 months, was there ever a time when you felt that you needed health care

but you didn’t receive it?)

Community Manitoba* Presence of

Unmet Health

Care Needs # % # %

Yes (1) 17,009 13

No (2) 113,742 86

Don’t know (7) 104 .07

Total sample size 130,880 100

*Source: Canadian Community Health Survey (Statistics Canada), 2003

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 78

H-5 Reported Smoking

Framework Section Health

Indicator Reported Smoking

Relevance Smoking is linked to increased risk of poor general health,

mortality linked to cardiovascular disease, cancer, and

respiratory problems.

Information Source

Statistics Canada

Manitoba Centre for Health Policy

Canadian Community Health Survey (CCHS)

Local

Calculation Formula

%100

__

_Re =x

sizesampleTotal

answerspondents

Calculation

Table H-5: Reported Smoking Behaviour, 2003

(At the present time do you smoke cigarettes daily, occasionally or not at all?)

Community Manitoba* Smoking

Behaviour # % # %

Daily (1) 30,077 23

Occasionally (2) 5,541 4

Not at all (3) 95,123 73

Total sample size 130,880 100

*Source: Canadian Community Health Survey (Statistics Canada), 2003

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 79

H-6 Alcohol Consumption

Framework Section Health

Indicator Alcohol Consumption

Relevance Consumption of alcohol may be linked to personal, family and health

problems.

Information Source

Statistics Canada

Canadian Community Health Survey (CCHS)

Local

Calculation Formula

%100

__

_Re =x

sizesampleTotal

answerspondents

Calculation

Table H-6: Alcohol Consumption, 2003

(Did you ever regularly drink more than 12 drinks a week?)

Community Manitoba* Alcohol

Consumption # % # %

Yes (1) 3,488 3

No (2) 14,719 11

Not applicable 111,999 86

Don’t know (7) 36 0.03

Total sample size 130,880 100

*Source: Canadian Community Health Survey (Statistics Canada), 2003

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 80

H-7 Physical Activity

Framework Section Health

Indicator Physical Activity

Relevance Engagement of community residents in physical activity

can be seen as a measure of quality of life.

Information Source

Statistics Canada

Canadian Community Health Survey (CCHS)

Local

Calculation Formula

%100

__

_Re =x

sizesampleTotal

answerspondents

Calculation

Table H-7: Person’s participating In Daily Physical Activity for More Then 15 Minutes,

2003 (Are you physically active for more then 15 minutes each day?)

Community Manitoba Participation in

Physical Activity # % # %

Yes (1) 41,154 31

No(2) 81,265 62

Not stated (9) 8,461 7

Total sample size 130,880 100

*Source: Canadian Community Health Survey (Statistics Canada), 2003

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 81

H-8 Reported Obesity

Framework Section Health

Indicator Reported Obesity

Relevance Obesity is an established risk factor for coronary heart

disease, diabetes, and certain types of cancer.

Information Source

Statistics Canada

Canadian Community Health Survey

Local

Calculation Formula

%100

___20__

___20__ =

>

>x

ageofyearspopulationTotal

ageofyearspopulationObese

Calculation

Rural Community Health and Well-Being: A Guide to Action 82

Table H-8: Household Population Aged 20 to 64 Excluding Pregnant Women Who Are

Obese, Overweight, Acceptable, And Under Weight (counts and rates by international

standard for body mass index)

Community Canada*

Reported Weight Categories # % # %

Total household population 18,381,000 100

Obese** 2,787,000 15

Overweight 6,075,000 33

Acceptable weight 9,026,000 49

Underweight 493,000 3

Men

Obese 1,508,000 8

20-34 393,000 26

35-44 424,000 28

45-54 432,000 29

55-64 259,000 17

Overweight 3,742,000 20

Acceptable weight 4,031,000 22

Underweight 107,000 0.6

Women

Obese 1,280,000 7

20-34 297,000 23

35-44 351,000 27

45-54 361,000 28

55-64 271,000 21

Overweight 2,333,000 13

Acceptable weight 4,995,000 27

Underweight 386,000 2

*Source: Statistics Canada,2000/2001

**Obesity is defined as having a Body Mass Index (BMI) over 30

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 83

H-9 Preschool Child Screening

Framework

Section Health

Indicator Preschool Child Screening

Relevance Identifies developmental problems and need for resources.

Information

Source Local

Calculation

Formula

%100

____#

_______# =x

childrentestedofTotal

problemtdevelopmenspecificwithchildrenofTotal

Calculation

Table H-9: Number of Children Screened for Developmental Problems

Presence of Developmental

Problem

Type of Developmental Problem Number of Children

Screened # %

Vision

Hearing

Motor

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 84

H-10 Immunization Programs

Framework

Section Health

Indicator Immunization Programs

Relevance Indicates the extent to which residents have been protected against diseases.

Information

Source

Statistics Canada

Manitoba Information Management System (MIMS) Database

Manitoba Centre for Health Policy

Local

Calculation

Formula

%100

_______15__

________ =

<x

periodtimesametheatageofpopulationTotal

regimenparticularawithimmunizedchildrenofnumberTotal

Calculation

Table H-10: One-Year Immunization Rates, Manitoba Average 1998-2000

Community Manitoba*

Number % Number %

Total number of children 31653 100

Children receiving full immunization by one

year of age 26742 84.5

*Source: Manitoba Centre for Health Policy, 2000

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 85

H-11 Selected Diseases and Disorders

Framework Section Health

Indicator Selected Diseases And Disorders

Relevance Change in incidence rate of certain diseases and disorders

reflects trends in risk factors and exposure and help

identify areas of concern for action.

Information Source

Manitoba Health

Manitoba Centre for Health Policy

Local

Calculation Formula

Count, tabulate and describe

Table H-11: Selected Diseases and Disorders**

Local RHA* Manitoba*

Disease/Disorder 1996 2001 Change 1996 2001 Change

*Source: Manitoba Centre for Health Policy

**Examples of diseases of the circulatory system, mental disorders, and cancer. The communities will choose

which examples are used in the table.

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 86

H-12 Communicable Diseases

Framework

Section Health

Indicator Communicable Diseases

Relevance Change in incidence rates of communicable diseases may identify areas

of concern for action.

Information

Source

Manitoba Health

Manitoba Centre for Health Policy

Local

Calculation

Formula

%100

___

________ =x

casesofnumberTotal

bracketageparticularaincasesofnumberTotal

Calculation

Table H-12: Number Of Cases Of Influenza A By Age Group, Manitoba 2003/2004

Community Manitoba*

Age group # of cases % of total # of cases % of total

<1 yrs 18 10.9

1-4 yrs 15 9.1

5-9 yrs 9 5.5

10-14 yrs 8 4.8

15-19 yrs 4 2.4

20-24 yrs 10 6.1

25-29 yrs 7 4.2

30-39 yrs 7 4.2

40-49 yrs 6 3.6

50-59 yrs 4 2.4

60-69 yrs 4 2.4

70-79 yrs 16 9.7

>79 yrs 57 34.5

missing 0 0

*Source: Manitoba Health, 2003/2004

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 87

H-13 Selected Cancers

Framework

Section Health

Indicator Selected Cancers

Relevance Change in the incidence rates of cancer may contribute to identification of

environmental and other factors linked with certain types of cancer.

Information

Source

Statistics Canada

Manitoba Centre for Health Policy

Cancer Care Manitoba

Local

Calculation

Formula

ratex

yeartheofendtheatpopulationTotal

yeargivenaforcancerselectofcasesnewofNumber =1000/1

_______

__________

Calculation

Table H-13: Canadian Cancer Incidence, Age-Standardized Rate per 100,000

Population

Community Manitoba* Types of cancer

Male Female Male Female

Malignant neoplasms 483.4 359.4

Lung cancer 78.2 47.1

Colorectal cancer 66.5 44.0

Female breast cancer 104.2

Prostate cancer 122.3

*Source: Statistics Canada

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 88

H-14 Causes of Death

Framework Section Health

Indicator Causes of Death

Relevance May be important for determining future health prevention

and promotion activities.

Information Source

Manitoba Centre for Health Policy

Cancer Care Manitoba

Local

Calculation Formula

%100

__

_____ =x

deathsnumberTotal

deathofcausesspecificofNumber

Calculation

Table H-14: Causes of Death

2004 2003

Cause of death Number % Number %

Circulatory

Cancer

Respiratory

Injuries

Drowning

Falls

Poisoning

Vehicle

Violence by others

Violence to self

Other

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 89

H-15 Health Services Availability

Framework Section Health

Indicator Health Services Availability

Relevance Measures health services available to the community.

Information Source

Local

Calculation Formula Count, tabulate and describe

Table H-15: Health service availability

Services Available in

Community (√)

Available within

1 hour (√)

Travel time

Dentist

Ophthalmologist

Optometrist

Chiropractor

Family Physician

Audiologist

Physiotherapist

Naturopathic Physician

Massage Therapist

Acupuncture Specialist

Psychologist

Midwife

Other (specify)

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 90

H-16 Hospital Services Utilization

Framework Section Health

Indicator Hospital Services Utilization

Relevance Indicates where people are going for hospital services and

who is using the hospital services.

Information Source

Manitoba Health

Local

Calculation Formula

Count, tabulate and describe

Table 16a: Use of Local Hospital by Community of Residence

Community Hospital Cases (i.e. #’s) Hospital Days

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 91

Table 16b: Hospital Utilization by Residents of the Community

Community Manitoba

Hospital Cases Days Hospital Cases Days

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 92

Table 16c: Deliveries at Local Hospital by Mother’s Home Community

Community 2001 2002 2003 2004

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 93

Calculation Formula

%100

___

_//___ =x

babiesofnumberTotal

babiesstillbornliveweightspecificofNumber

Calculation

Table 16d: Births at local hospital by weight

Hospital Manitoba hospitals Weight in grams

Number % Number %

0000-0499 Live 32 0.19

Stillborn 46 0.27

0500-0999 Live 61 0.36

Stillborn 30 0.18

1000-9998 Live 16.810 98.55

Stillborn 67 0.39

Uknown Live 9 0.05

Stillborn 2 0.01

Total Live 16.912 99.15

Stillborn 145 0.85

Total births 17,057 100.00

*Source: Mantiba Health, 1994/1995

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 94

Table 16e: Local Hospital Admission by Accident Classification*

Community Manitoba

Description Number of

cases Number of

days Description Number of

cases Number of

days

Source: Manitoba Health, 1995

*Examples of accidents include Motor vehicle accidents, railway accidents and accidental falls. The

communities will choose which examples are used in the table.

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 95

Table 16f: Use of Hospitals by Local Residents by Surgery Classification

Type of Surgery Wpg.

In Pt. Wpg.

Days Comm.

In. Pt. Comm.

Days Region

In. Pt. Region

Days Other R.

In. Pt. Other R.

Days Total

In. Pt. Total

Days

Nervous System Admiss 8 370

Day vt 4

Endocrine Admiss 2 5

System Day vt

Eye Admiss 6 17

Day vt 24

Ear Admiss 3 9

Day vt 4

Nose, Mouth, Admiss 13 177

Pharynx Day vt 6

Respiratory Admiss 5 47

Day vt 4

Cardio-vascular Admiss 19 174

System Day vt 11

Hemic & Admiss 5 130

Lymphatic Day vt 1

Digestive Admiss 60 574

System Day vt 56

Urinary Admiss 12 159

Day vt 16

Male Genital Admiss 3 13

Organs Day vt 7

Female Genital Admiss 9 34

Organs Day vt 53

Obstetrical Admiss 11 40

Day vt

Musculoskeletal Admiss 41 386

Day vt 27

Integumentary Admiss 14 169

Day vt 16

Diagnostic/ Admiss 31 204

Therapeutic Day vt 39

Total Admiss 242 2508

Day vt 268

Source: Manitoba Health, 1995

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 96

Table 16g: Use of Hospitals by Residents of Local Community Members

Diagnostic

Classification Wpg.

In Pt. Wpg.

Days Comm.

In. Pt. Comm.

Days

Region

In. Pt. RegionD

ays Other R

In. Pt. Other R

Days Total

In. Pt. Total

Days

Infectious/ Admiss 5 57

Parasitic Day vt

Neoplasms Admiss 27 446

Day vt 25

Endocrine/ Admiss 5 17

Nutri/Metab Day vt 1

Blood/ Admiss

Blood Organs Day vt

Mental Admiss 6 533

Disorders Day vt

Nervous Admiss 8 148

System/Senses Day vt 38

Circulatory Admiss 30 274

Day vt 16

Respiratory Admiss 15 123

Day vt 4

Digestive Admiss 44 145

Day vt 37

Genitourinary Admiss 16 83

System Day vt 36

Obstetrical Admiss 25 60

Conditions Day vt 36

Skin & Sub. Admiss 5 114

Tissue Day vt 2

Musculo- Admiss 31 173

skeletal Day vt 30

Congenital Admiss 15 152

Anomalies Day vt 6

Perinatal Admiss 3 27

Conditions Day vt

Ill-defined Admiss 6 25

Conditions Day vt 10

Injury and Admiss 32 619

Poisoning Day vt 2

Factors-Hlth Stat/ Admiss 34 409

Cont with System Day vt 26

Total Admiss 307 3405

Day vt 269

Source: Manitoba Health

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 97

H-17 Hospital Occupancy Rate

Framework Section Health

Indicator Hospital Occupancy Rate

Relevance Shows the hospital usage.

Information Source

Local

Table H-17: Hospital Occupancy Rate

Occupancy Rate

2003

2002

2001

2000

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 98

He -18 Home Care Utilization

Framework Section Health

Indicator Home Care Utilization

Relevance The availability and utilization of home health supports.

Information Source

Local

Calculation Formula

Count, tabulate and describe

Table H-18: Home Care Utilization

Type of Home Health Supports Availability Utilization

Nurses aide

Home care attendant

Licensed practical nurse

Registered nurse

Other (specify)

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 99

H-19 Personal Care Homes Utilization

Framework Section Health

Indicator Personal Care Homes Utilization

Relevance Indicates the availability and utilization of services for

residents who need the level of care that personal care

homes provide.

Available

Information Source

Local

Calculation Formula

Count, tabulate and describe

Table H-19: Personal Care Home Utilization

2003 2002 2001 Personal

care

home # of

beds Occupancy

rate Average

waiting

time for

placement

# of

beds Occupancy

rate Average

waiting

time for

placement

# of

beds Occupancy

rate Average

waiting

time for

placement

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 100

Safety & Security Indicators Worksheets

Saf-1 Emergency Programs

Framework Section Safety & Security

Indicator Emergency Programs

Relevance Shows the degree to which a community is prepared for

disasters that may occur. Regular training of emergency

personnel, testing and adjusting of the plan indicates that

municipal, town and regional health authority leaders are

practicing a proactive approach to disaster preparedness.

Information Source

Local

Calculation Formula

Count, tabulate, describe

Is there a town-municipal disaster plan? If so, is the plan

“tested” on a regular basis? What is the frequency of the

testing? Are emergency services personnel trained to

respond and act within the plan?

Table Saf-1: Emergency Programs -- Disaster Plan (√)

Community Hospital Personal

Care Home School Fire Dept. Other

(specify)

Date tested

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 101

Saf-2 Community Safety and Security Programs

Framework Section Safety & Security

Indicator Community Safety and Security Programs

Relevance Shows involvement of participants in community safety

and security programs such as Neighbourhood Watch,

Block Parent, Citizens on Patrol, Juvenile Justice.

Information Source

Local

Calculation Formula

Count, tabulate and describe

Table Saf-2: Community Safety and Security Programs

Program Presence (√) Number of Members

Block Parent

Citizens on Patrol

Juvenile Justice

Neighbourhood Watch

Other

What does the information mean?

What are the implications?

What should the follow up be?

Rural Community Health and Well-Being: A Guide to Action 102

Saf-3 Ambulance Responses

Framework Section Safety & Security

Indicator Ambulance Responses

Relevance Measures the activity of the ambulance service that may

have an impact on emergency services planning.

Information Source

Local

Calculation Formula

%100

___

_____ =x

responsesofnumberTotal

categorybyresponsesofnumberTotal

Calculation

Table Saf-3: Percentage of Responses to Emergent, Urgent, Non-Urgent, and Planned

Transport Calls

Total Number of

Responses

Percentage of

Responses per Year

Type of Response Total Number of

Responses By

Rural Community Health and Well-Being: A Guide to Action

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