Canadian approaches to the promotion of health in small workplaces.

The promotion of health in small workplaces is particularly challenging. Research was conducted to identify the types of agencies offering prevention and promotion services to small workplaces, and to describe the activities and strategies used to engage this "hard-to-reach" population. This paper reports on a survey of 58 agencies located across Canada. Agencies were mostly of recent origin, many having arisen in response to legislative and other government initiatives, and of two essential types: those that used the workplace as a site for addressing general lifestyle health behaviours, and those addressing the occupational determinants of health. Their location, staffing and program focus reflected their orientation. Factors believed by respondents to influence program effectiveness are summarized. The paper notes the top-down origins of many prevention/promotion efforts, their inherent management bias, and the differing perspectives that underlie the lifestyle and occupational approaches to workplace health. A call for integration of the two approaches is made.

Back problems are for life: Perceived vulnerability and its implications for chronic disability.

As part of a qualitative research study of the experience of work-related back problems, a series of in-depth ethnographic interviews were conducted with 15 workers receiving treatment for back injuries. Analysis of these data revealed that the workers perceived their back problems as lifelong problems. Many believed that their back injuries had permanently heightened their vulnerability to reinjury and chronic disability. Accommodating this sense of physical vulnerability required a redefinition of one's self and one's future. For some workers, the perceived threat of future back problems was itself disabling and appeared to discourage a return to normal social roles. Workers' interactions with the health care system shaped their perceptions of their bodies and their notions of the appropriate means to cope with their physical vulnerability. Implications of the perception of permanence for the development of chronic disability among workers who experience back problems are examined.

A critical perspective on research and knowledge development in health promotion.

The paper addresses four issues that pervaded conference deliberations: the relevance of qualitative approaches to research, the importance of community participation in the research process, the need to broaden the disciplinary base of health promotion, and the possibilities for a critical research perspective. The paper suggests why the idea of qualitative methods is so appealing to health promotion researchers, and what may prevent such methods from living up to the expectations held of them. The emphasis on community participation in research expresses an attempt to make research more relevant and accountable, but it also may inhibit the theoretical grounding of research, and create strain between pragmatic and scientific interests. The field of health promotion is inherently multidisciplinary, but it remains unclear if and how different disciplines can be effectively combined or integrated. The relative absence of critical thought at the conference is noted, and the authors argue that a critical perspective is needed in both "research of" and "research for" health promotion.

Leaving it up to the workers: sociological perspective on the management of health and safety in small workplaces.

Small workplaces present particular challenges for the promotion of occupational health and safety. However, little is known about the social organization of work in such settings and how it relates to matters of health and safety. The research on which this article is based relates patterns of occupational health behavior to the nature of social relationships within the workplace. From a qualitative analysis of interviews with 53 small business owners, the author describes the most common approach to managing workplace health and safety: leaving it up to the workers. This posture is explained in terms of the owners' perception of risk, particularly their understanding of workplace hazards, and their assessment of the social costs of ignoring or addressing such issues. Owners tended to discount or normalize health hazards, and to believe that management intervention in employee health behavior was paternalistic and inconsistent with prevailing patterns of labor relations and norms respecting individual autonomy. Many owners understood health and safety not as a bureaucratic function of management but as a personal moral enterprise in which they did not have legitimate authority. The conceptualization of the owners' responses in terms of "social rationality" has implications for addressing problems of health and safety in small workplaces.

Physicians' perception of personal risk of HIV infection and AIDS through occupational exposure.

Physicians' response to acquired immune deficiency syndrome (AIDS) is poorly understood and often attributed to fear of human immunodeficiency virus (HIV) infection through occupational exposure. We surveyed 268 physicians from three geographic regions in North American with different specialties and responsibilities for HIV-positive patients. An important difference was found between the published risk and the physicians' perceived risk of infection after a single occupational exposure. Almost half of the respondents stated that they feared contracting AIDS more than other diseases. The physicians who perceived themselves to be at high physical risk were more likely than the others to report that AIDS had changed the way they interact with their patients (r = 0.26, p less than 0.001). No relation was found between the perception of physical risk and the number of HIV-infected patients (r = -0.07, p = 0.15). However, the perception of social risk showed a small inverse correlation (r = -0.15, p less than 0.02), in which the physicians with more HIV-infected patients reported less concern about negative social consequences. The physicians who perceived themselves to be at high personal risk were more likely than the others to report that surgeons have the right to refuse patients who do not wish to undergo HIV antibody testing (r = -0.16, p less than 0.01 for physical risk; r = -0.29, p less than 0.001 for social risk). Multiple regression analyses indicated that physicians' perception of physical risk was not related to age or sex but was modestly related to income source. The perception of social risk was related to sex and income source. Physicians' perception of personal risk is a crucial, yet often unacknowledged, component of the fight against AIDS. Our findings suggest that lack of attention to this issue is seriously compromising initiatives designed to facilitate physician participation in AIDS care.

Children's health and illness behaviour: the single working mother's perspective.

This study explored how single working mothers perceive and deal with concerns about their children's health. "Grounded theory" analysis of data from interviews with single mothers in a wide variety of circumstances suggested that contextual factors including the mother's work situation, child care and social network are important to understanding the health and illness behaviour of these families. Children's use of health services appeared to reflect the single mother's attempts to manage her roles as mother (nurturer) and worker (provider), and her sense of role flexibility. A sense of flexibility appeared to mitigate role conflict and to interact with other known influences of health services utilization including the quality of the client/practitioner relationship. The mother's sense of flexibility appeared to vary with her income, child care arrangement, work situation (e.g., emphathetic supervisor), access to tangible support (e.g., child care) and social network (i.e., proximity to her family of origin).

Factors associated with enrollment in an employee fitness center.

Employee fitness programs may be evaluated by comparing program participants with nonparticipants on program outcome variables. This study was designed to identify how participants in an employee fitness program may selectively differ from nonparticipants. Joiners were more likely to have engaged in prior fitness activity, to consider fitness a high priority, and to have more positive attitudes about keeping fit. Traditional factors such as demographic or health status variables were not different between joiners and nonjoiners. Although the fitness center was not systematically selecting the more fit employee, participants were different from nonparticipants in terms of attitudinal and behavioral factors which reflect a health promotion orientation.

Survival of the fittest? The democratization of hospital administration in Quebec.

In 1973 the Canadian Province of Quebec "democratized" its hospital boards of directors by replacing their traditional lay community or religious members with individuals more representative of the hospitals' major interest groups. In the province's English-speaking hospitals, patients, community organizations, physicians and nonprofessional hospital employees elected representatives to boards that were formerly comprised mostly of business executives. After a brief description of the social organization of the former "elite" boards and their role in the distribution of power within hospitals, the paper demonstrates how the "elite" board members and hospital administrators retained control despite "democratization." Several theoretical explanations for this outcome are critically examined in the light of these empirical findings. One suggestion is that the "elite" administration survived democratization because it was "fitter" in terms of ability to influence the hospitals' major economic and political constraints.

Hospital power structure and the democratization of hospital administration in Quebec.

In 1973, the Canadian Province of Quebec 'democratized' its hospital boards of directors by replacing the previous 'elite' boards by boards representative of the hospitals' major interest groups. This study looks at the impact of these participatory boards on the distribution of power within hospitals, particularly their effect on the hospital administrators' position of control in relation to their boards of directors and medical staff. Findings include a deterioration in the administrators' sense of organizational control, a weakening of the boards' authority over physicians, and a concentration of decision-making outside of the boardroom.