Key to Women’s Health: Phase 2
Presentation Guidebook for Health and Social Services
Quick facts about Women and Stroke
Overview of the Project
Lessons from Key to Women’s Health
Discussion: what this means for your work
and organization
Women and Stroke
According to the Heart and Stroke Foundation of Canada:
Women have 60% of 50,000 strokes yearly
More women than men die as a result of stroke
There are risk factors and symptoms of stroke
specific only to women
Women are less likely to receive the right treatment
(2007 Report on Canadians' Health, Heart and Stroke Foundation of Canada, 2007)
Furthermore, twice as many women
die from stroke as breast cancer.
What Did We
Wish to Learn?
We wanted to know what marginalized women
know about:
> Health in general
> Risks, signs and symptoms of stroke
> How to find and use information
about health and stroke
Who is Marginalized?
Marginalized women are women whose access to health
is limited by their access to the social determinants of
health, such as:
income and social status
social support networks
education and literacy
employment/working conditions
Marginalized women also experience
discrimination based on their ability,
race, gender sexual orientation, class, etc.
Who Are We?
Current Project Partners:
Asset Mapping Research Project, TCRC
Health Nexus
Heart and Stroke Foundation of Ontario
Ontario Women’s Health Network
Region of Peel, Department of Public Health
South East Toronto Stroke Network, SMH
Sudbury Women’s Centre
Toronto Public Health
Project History
We based Key to Women’s Health
on two previous initiatives:
Count Me In! (Health Nexus, 2005) developed
a made-in-Canada definition of inclusion
Count Us In! (OWHN, Health Nexus, TCRC,
Toronto Public Health, 2006) used that
definition to research the health and social
service needs of homeless and underhoused
women in Downtown East Toronto
Key to Women’s Health is founded
in the belief of Inclusion
A society where everyone belongs creates both
the feeling and the reality of belonging and helps
each of us reach our full potential.
The feeling of belonging comes through caring,
cooperation, and trust. We build the feeling of
belonging together.
The reality of belonging comes through equity and
fairness, social and economic justice, and cultural
as well as spiritual respect. We make belonging
real by ensuring that it is accepted and
practiced by society.
(Count Me In, Health Nexus, 2005)
Inclusion Research
A methodology that includes populations
under study in the research itself.
This unites researchers with actual
members of the communities, in order
to find new and more appropriate
policy approaches to difficult
Inclusion Research
We recruited women who are marginalized
and who have limited access to the social
determinants of health
We hired, trained and supported these women,
as Inclusion Researchers (IRs), to listen to
other women in similar circumstances and
participate in every stage of the project
Provincial Working Group
A Provincial Working Group connected this
project with agencies and networks in
stroke, chronic disease prevention and
community-based research
The Provincial Working Group was diverse
and collaborative, and included IRs in all
aspects of the work
Local Advisory
Local Advisory Committees ensured that the
project was connected to resources in the
The social determinants of health were
represented through the various members
of the Local Advisory Committees
IRs played crucial and continuing
roles in each of the Local
Advisory Committees
Sites & Coordination
Sudbury: a diverse population living in a northern
city and adjacent rural area (Sudbury Women's
Peel: South Asian immigrant women with
language barriers, living in a suburban area
(Reg. of Peel, Dept. of Public Health & India
Rainbow Community Services of Peel)
Downtown East Toronto: urban
homeless and underhoused women
living in poverty (Asset Mapping
Research Project, CRC)
Literature Review
“Women who experience or face challenges
in relation to the determinants of health
often do not survive a stroke…if they do not
have the family support system to ensure
their rehabilitation, they inevitably suffer
from further strokes.”
(Key to Women’s Health, OWHN, 2006)
Literature Search
Not much connecting feminist,
participatory research to the social
determinants of health
Not much about how information on the
risks, signs and symptoms of stroke is
transferred to marginalized women
No specific statistics available on
women in these circumstances
Research Strategy
A Line of Questioning was developed
through intensive consultation
Focus groups were recruited in each
of the 3 sites, reflecting diversity
15 Inclusion Researchers were
trained to conduct and record
the results of the focus groups
Line of Questioning
We asked women who are marginalized and
located in urban, suburban and rural settings
how they:
Define health
View inclusion/exclusion in service delivery
Understand the risks, signs
and symptoms of stroke
Prefer to learn about stroke
and stroke prevention
Focus Groups
IRs worked in pairs to conduct 10
focus groups at the 3 sites with 70
Participants were recruited through
outreach among cooperating
community agencies
Data Analysis
Dr. Suzanne Jackson, Centre for Health
Promotion, led the collective analysis of data
to identify general and specific findings
The analysis team included Provincial
Working Group, members of Local
Advisory Committees, Coordinating
Agencies and all the Inclusion
Focus Group:
General Findings
Participants reported:
A comprehensive view of health, with a focus
on emotional, financial, spiritual, family,
community and social factors
Challenges with access to the social
determinants of health, complicated by
language, culture and geography
Focus Group:
General Findings
Current education approaches to stroke
sometimes cause/increase stress
Difficulty discussing health issues with their
families because of cultural barriers
Little knowledge about the risks,
signs and symptoms of stroke
Focus Group:
General Findings
Preference for multi-channel ways to find
out about stroke through highly targeted
Preference for small circles to learn about
and act on health issues, like stroke
Specific Findings
Findings were clustered into the four lines of
What is Health?
Risks, Signs and Symptoms of Stroke
Best Way to Reach Women
What is Health?
Participants had a holistic understanding of
health, involving 8 elements:
The Health System
Findings were clustered into the four lines of questioning:
We heard few instances of healthcare experiences where
women felt included. When they did feel included they:
felt welcome when they were greeted
felt recognized as an individual
saw quick results
were helped with the costs of their healthcare
The feeling of belonging made them feel valued.
Far more prevalent are the experiences of
exclusion that women shared with us:
Racial discrimination and racialism
Language and cultural barriers
Feelings of isolation, being unwelcome
Unfair assumptions, especially
about sexuality
Long waiting times
Far more prevalent are the experiences of
exclusion that women shared with us:
Not enough coverage for all required
services, including ambulance, drugs
and dental care; need jobs to pay
for health care services
Poor accessibility to services,
especially emergency services,
because of cost and distance
Signs and Symptoms
of Stroke
The signs and symptoms of stroke are:
Sudden loss of strength or
sudden numbness in the face,
arm or leg, even if temporary
Trouble speaking
Sudden difficulty speaking or
understanding or sudden
confusion, even if temporary
Vision problems
Sudden trouble with vision,
even if temporary
Sudden severe and unusual
Sudden loss of balance,
especially with any of the
above signs
If you experience any of these symptoms,
CALL 9-1-1, or your local
emergency number immediately.
Symptoms Specific
to Women
In addition to or instead of the traditional stroke signs, a
woman may have:
Loss of consciousness
or fainting Shortness
of breath
Sudden hiccups
Falls or accidents
Sudden tiredness
Sudden pain in the
face, chest, arms or legs
Sudden pounding
or racing heartbeat
Sudden nausea
(Stroke symptoms in women: Know the unique warning signs,
Mayo Foundation for Medical Education and Research, 2007)
Symptoms Specific
to Women
Women having a stroke are more likely
than men to delay seeking treatment.
That women experience the traditional
symptoms of stroke less often than men,
and are more likely to have and report
an alternative symptom first, may be
the cause for this delay.
(Stroke symptoms in women: Know the unique warning signs,
Mayo Foundation for Medical Education and Research, 2007)
What are the Risks
for Stroke?
Participants identified these risks for women:
Lack of knowledge about stroke
Poor physical health, including improper
diet, lack of exercise and weight gain
Smoking, drugs and alcohol
Birth control
Risks for Stroke
Women also identified:
Family and home life stresses
Mental health issues
Lack of clinical services and advice
Physical environment
Additional Risks
for Stroke
Research and women identify additional risks
for marginalized women:
Lack of income/jobs
Literacy and language barriers
Key to Women’s Health…
works to increase the
recognition of the signs,
symptoms and risks of stroke
through diverse programming
grounded in the social
determinants of health.
Best Way
to Support Women
“It’s easier for us to come
to groups like this one
(even once a month)
to gain health information.”
(focus group participant)
Best Way
to Reach Women?
Community outreach strategies, rooted in our
lived lives
Information from peers
Highly localized advertisements, in
multi-lingual and multi-media formats
Information exchanged in medical or
health transactions,
including alternative health
Creating the Framework
Key Concepts:
> Health is comprehensive and holistic,
with 8 key elements and should be talked
about in simple, plain language
Intimate, sharing and caring environment of
peer-led small groups are the best way
Geographic, cultural, socio-economic and
linguistic differences should be noted
The Key
“Life is bigger than stroke.”
(focus group participant)
Creating the Framework
Key Principles:
> We must have security and trust
> We must be able to speak without fear
> We must have accountable systems
> We must have the presence of a
known and trusted person in the
room to allow us to feel safe
Health Promotion
The Health Promotion Framework
used the concepts and principles
for three linked campaigns:
> Awareness
> Advocacy
> Outreach
Awareness Campaign
The Awareness Campaign should:
> Use images of ordinary women and cultural
icons from the diverse communities
> Create flyers, posters, TV or radio
ads with these women’s images
> Use plain language
> Use multiple languages and
multiple cultural perspectives
Advocacy Campaign
The Advocacy Campaign should support:
> Increased welfare rates, more affordable
housing, other elements of health
> Subsidized dental and eye care,
medicine and reduced pharmacy fees
> Free public transit for visits to
doctor’s offices and
health centres
Advocacy Campaign
Improved access to all parts of the health
system, especially for newcomers:
> Simplified process of applying for health
> Recognition of credentials of foreigntrained healthcare professionals
> Provide immigrating peoples with
information about the health
care system
Outreach Campaign:
Women’s Health Circles
In Key to Women’s Health Phase 2, in response to the finding that
women prefer to receive health information in group talks, we
piloted such talks and called them Women’s Health Circles. We:
Trained IRs as facilitators to organize and lead
Held the circles in diverse places, such as
community centres and shelters, with
appropriate language and
cultural support
Women’s Health Circles
Outreach Campaign:
Women’s Health Circles
In a Women’s Health Circle:
The topic of discussion and agenda is decided by the women and
rooted in the lived experiences of these women
Healthcare professionals can be invited to give a presentation
and to listen in on the discussion as a participant
The circles cover the 8 elements of health and
at some point incorporate the risk factors and
signs and symptoms of stroke
The circles provide an opportunity to explore
issues such as abuse, isolation, employment,
etc. as selected by the women
Women’s Health Circles:
How you can run them
Download OWHN’s handbook on how to run a
Women’s Health Circle
Contact OWHN for further support
Visit our website at
or email us at
Thank You's
Thank you to the women who participated.
Thank you to our funders who have supported the
development of Inclusion Research:
Ontario Ministry of Health Promotion
Ontario Ministry of Health and Long Term Care
Wellesley Institute
Public Health Agency of Canada
Ontario Trillium Foundation
Contact us
For more information:
Ontario Women’s Health Network
Over to You!
And now we ask you to join us by
considering these questions:
What do the findings mean for your work
and your workplace?
What actions might you take to create
changes suggested by the findings?
How can you engage women you serve
more in the program planning and
delivery of services?