CAPACITY BUILDING:
THE EXPERIENCE OF HEALTH EDUCATION WORKERS IN THE YUKON

Janet E. Horton
B.Sc.N., University of Saskatchewan, 1971

Thesis Submitted in Partial Fulfillment of
The Requirements for The Degree of
Master of Science
in
Community Health Science

The University of Northern British Columbia
February 2006
© Janet E. Horton, 2006

1^1

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ABSTRACT
Population health literature holds that influencing the determinants of health will
enable health inequities to be redressed and health outcomes improved. The question
arises of how determinants of health can be addressed in community health practice. The
study explores the use of a capacity building approach as a means to address health
determinants in the Yukon context.
Research was conducted with Yukon health education workers, through
individual and small group interview, to explore their understanding, experience and
observations of the outcomes of capacity building. All participants were associated with
the Yukon College Public Health and Safety unit as employees or program instructors.
Participants were randomly selected from four Yukon community size groupings, to
allow identification of common themes across varied settings.
Findings about capacity building are reported in relation to meaning, process,
health education worker role, Yukon context and effects of activity. Predominant themes
that emerged indicate the importance of building on strengths, achieving an end of
immediate importance within the context and living in relationship with the community
when undertaking capacity building activity. Implications for policy, community health
practice, and further research are identified.

11

TABLE OF CONTENTS

Abstract

11

Table of Contents

111

List of Tables

VI

Acknowledgements

vii

Chapter One

Chapter Two

Introduction
Background
Health inequities in the Yukon
Potential of capacity building to address health inequities
Yukon context
Personal perspective
Purpose
Research question
Conclusion
Literature Review
Social theory
Meaning of capacity building
Definitions of capacity building
Thinking behind capacity building
Capacity building as an approach to health promotion
Summary
Process of capacity building
Approaches to capacity building
Activities of capacity building
Actors and their purposes in capacity building
Summary
Outcomes of capacity building
Rationale for examining outcomes
Domains and indicators
Summary
Concepts related to capacity building
Determinants of health
Population health

Health equity
Social capital
Community resiliency
Summary
Conclusion

1

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ill

Chapter Three

Methodology
Research method
Approach to research design
Setting
Participant selection
Conduct of interviews
Data collection
Data analysis
Rigour
Ethics
Research design
Consent
Confidentiality
Ongoing relationships
Conclusion

35
35
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50

Chapter Four

A bud opening in the sunshine; The meaning of capacity
building
Introduction
Role of the organization
Meaning of capacity building
Building on strength
Building on opportunity
Empowerment
Having effect beyond the individual
Conclusion

51
51
51
53
54
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61
62

Working together: Process and role of health education worker
Process
Initiating activity
Organizing program delivery
Teaching
Role of health education workers
Initiating activity
Building own capacity
Enabling achievement
Understanding meaning
Building relationships

65
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Chapter Five

Living in relationship with com m unity

Chapter Six

78

Conclusion

79

A stepping-stone: Yukon context and effects
Influence of Yukon context
Skills have meaning in the Yukon
Credibility of skills within and beyond the Yukon

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IV

Chapter Seven

Need to adapt resources to Yukon context
Effects of capacity building
Individual effects
More safe and healthy choices
Confidence
Self-reliance
Stepping-stone to future achievement
Linking individual and community capacity building
Individual decisions
Social responsibility
Community services
Summary
Conclusion

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What does it all mean? Summary and implications
Themes
Building on strengths
Meaning
Practice
Outcomes
Achieving an end of immediate importance
Meaning
Practice
Outcomes
Living in relationship with the community
Practice
Conclusion
Implications
Implications for policy
Implications for community health practice
Implications for research
Limitations
Conclusion

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106

References
Appendix A
Appendix B

107
Interview question guide
Sample section of data management table

113
114

LIST OF TABLES
Table 1

Community by size grouping and population with number of network
members

38

VI

ACKNOWLEDGEMENTS
My thanks go first to the participants in my research project. Without the gifts of
their wisdom, experience and reflections on their capacity building work, this thesis could
not have been written. I hope that this paper helps in some small way to accurately
reflect and recognize the valuable contribution to Yukon life made by these people.
The quality of this work is a tribute to the standards for scholarship of all my
committee members. I particularly thank Martha MacLeod, my thesis supervisor, who
has guided me through the process, knowing that I did not always want to hear what she
was saying. Now, I am glad that she said it anyway.
My fellow students in Yukon Community Health and Social Work cohort have
been an inspiration and support. I am glad that we have traveled this road together.
Thanks to the friends who have asked how things were going, and then listened.
You know who you are. I owe you.
My family has cheered me every step of the way. An unexpected gift has been
the ability to relate to the experience of my children, Jennifer, Brian and Stephen, as we
have struggled through the vagaries of student life together. My parents and other family
members have wondered why I was doing this, but never doubted that I could. Most
especial thanks go to my husband, whose steadfast love sustains me always. Syd has
shown an uncanny ability to be present with beer, chocolate, a shoulder to cry on,
diversion, groceries, encouragement or champagne according to the needs of the moment.
I would not have missed this challenge for the world. My success in reaching this
point is shared with each of the people who have helped me along the way.

V ll

CHAPTER ONE
Introduction

The question of how to influence determinants of health as a community health
practitioner working within the health care system has perplexed me. Population health
literature holds that influencing the determinants of health will enable health inequities to be
redressed and health outcomes improved (Chomik, 2001; Federal, Provincial and Territorial
Advisory Committee on Population Health, 1999). Capacity building offers an approach to
working with people in a community to enable them to effectively address determinants of
health and to improve health outcomes (Bopp, GermAnn, Bopp, Baugh Littlejohns, & Smith,
2000; Hawe, Noort, King, & Jordens, 1997; World Health Organization, 1997). A capacity
building approach may offer a way of redressing health inequities and improving health
outcomes in the Yukon population. However, it is important to understand capacity building
in the context in which it occurs in order to be responsive to that context. (New South Wales,
2001; Smith, Baugh Littlejohns & Thompson, 2001). The study has been undertaken to gain
knowledge that can inform practice with potential to influence determinants of health.
Background
The background section presents contextual information on which the research
project is based. This includes information on health inequities in the Yukon, an exploration
o f the potential for capacity building to address health inequities, description o f the Yukon

context and an explication of the perspective that 1 bring to this project.

Health Inequities in the Yukon
Health inequities exist in the Yukon. Problems with health and social outcomes
persist despite significant investment in Yukon health and social services. Inequities are
reflected in death rates due to accident and injury that are more than three times the national
average (Timmermans, 1999), life expectancy that consistently falls below the national
average (Cappon, 1991; Timmermans, 1999; Yukon Health and Social Services, 1995,
Yukon Health and Social Services, 2003a) and the perception that alcohol and drug abuse is a
serious problem (Timmermans, 1999; Yukon Department of Health and Social Services,
2003b). Whitehorse residents have higher income, lower unemployment and higher
education than those in rural communities, reflecting economic and social disparity within
the Yukon (Timmermans, 1999). Health, in turn, is related to these socioeconomic
disparities. Self-rated health, considered a reliable indicator of health, has been shown to
increase with increases in income adequacy and quality of life for Yukon people (Yukon
Bureau of Statistics, 1994). This information suggests that Yukon health inequities are
related to social and economic factors, with rural residents more likely to be affected by poor
health. Health status improvements among Yukon people that have occurred over the last 25
years, particularly in the area of children’s health, have been attributed to progress in
facilitating self-determination and community development (Timmermans, 1999). Learning
how community health practitioners might work effectively to further improve health status
in the Yukon is a driving interest behind this study.
Potential o f capacity building to address health inequities
Capacity building is identified as one of the ways that community development can
occur and that health determinants can be addressed. In their research as health promotion

practitioners, Smith et ai. (2001) describe capacity building as the “essence of community
development” (p.31). Bopp et al. (2000) link capacity building and health determinants in
their definition of eommunity capacity as “the ability of people and communities to do the
work needed in order to address the determinants of health for those people in that place”
(p. 14). Increasing community capacity was identified as one of the priorities for health
promotion in the Jakarta Declaration on Leading Health Promotion into the 2 L ' Century
(1997). The Declaration clarified that health promotion “improves both the ability of
individuals to take action, and the capacity of groups, organizations or communities to
influence the determinants of health” (p.4). Hawe, King, Noort, Jordens & Lloyd (2000)
explain the value of capacity building succinctly:
The rationale for capacity building is simple. By building sustainable skills,
resources and commitments to health promotion in health care settings, community
settings and in other sectors, health promotion workers prolong and multiply health
gains many times over (p.2).
A capacity building approach holds potential to address health inequity through enabling
action on health determinants, action that occurs, at least in part, at a collective or community
level. It is, at heart, a hopeful approaeh, that may be aceessible to praetitioners in working
with individuals, organizations and communities and may truly facilitate the achievement of
health gains in Yukon communities. Given this potential, it is a matter of interest to
understand the praetice of eapaeity building in the Yukon, to determine if and how this
approaeh is being used, and to what effeet. As a group that has identified themselves as
taking a capacity building approach, the work o f a group o f Yukon health education workers

is studied in order to gain understanding of sueh practice. This study is a first step in
understanding the potential for a eapaeity building approach to be useful in addressing health
inequities in the Yukon.

Yukon Context
The Yukon is “the great, big broad land way up yonder” immortalized in the poetry of
Robert Service. It is a vast, sparsely populated land in the northwest corner of Canada.
Approximately three-quarters of the 30,255 Yukon citizens live in the capital city of
Whitehorse, with the balance living in sixteen communities throughout the territory. Rural
Yukon communities range in size from 57 to over 1800 people (Yukon Government, 2004),
all but one of which are accessible by road within one to six hours drive of Whitehorse. First
Nations people make up approximately one quarter of the population. The Yukon is a
wilderness land that has been home to First Nations people for millennia and that continues
to cast its spell on newcomers as it did on Robert Service.
Government plays a large role in the life of the Yukon. At several levels,
governments in the Yukon are responsible for delivering health and social services and other
services that impact on the determinants of health. Federal, territorial. First Nations and
municipal governments all have a role in public administration. Directly, public
administration accounts for 25.8% of the Yukon economy (Yukon Government, 2003).
Further economic activity is attributable to government expenditures on goods and services.
Federal, municipal and territorial government employees represented 36.3% of the total
employed workforce in 2002; this figure does not include employment by First Nations
governments (Yukon Government, 2003). We are a population that is extensively governed.
The question of whether and when we are well governed is, of course, contentious. An
indication of the contentiousness is that three different political parties held office in the
Yukon between 2000 and 2004. The role of government is emphasized for two reasons; one
is to note the extent to which governments at different levels are responsible for health and

social service delivery, the other is to illuminate the extent to which the exercise of power is
operational in the Yukon through these government structures. Both of these factors are
relevant to the practice and policy context in which capacity building occurs.
Working within the territorial health care system, I have often heard that there is need
for capacity building in the Yukon. Such comments may come from First Nations workers,
from health professionals, from people active in non-government organizations. In order to
gain a better understanding of what capacity building means and how to build it, it is useful
to learn how it is undertaken in the Yukon. The Yukon College Public Health and Safety
(YCPHS) manager indicated that the YCPHS unit takes a capacity building approach to their
work. The mandate of the unit is not a written one, but has been described by the manager as
being openness and effort to make safety training and health promotion accessible to Yukon
people, using resources such as Red Cross first aid training courses, food safe programs and
health promotion. The unit is part of the Yukon College Professional Studies division, whose
primary goal is to develop and deliver programs and services that enhance access to
employment for students, or assist them in achieving professional objectives (Yukon College,
2004a). The YCPHS unit functions within Yukon College, which strives as an organization
to help learners develop “a healthy balance of their whole person: intellectual, emotional,
spiritual, social and physical”, with knowledge and skills for successful living, to apply
problem-solving strategies to a variety of decision-making situations and to contribute to
their communities (Yukon College, 2004b, p.l). With their orientation to a capacity building
approach, a network of instructors throughout the Yukon, and a health promotion focus in
their work, the YCPHS instructors are a knowledgeable, Yukon-wide and accessible group of
people from whom much can be learned. This group provides a window into understanding

capacity building and influence on determinants of health through their role in community
education.
Personal Perspective
My perspective is that of a macro community health practitioner, operating from the
assumption that addressing broad issues of social policy can affect individual and collective
well-being, consistent with the views of Ricks and Charlesworth (2002). I believe that if a
community can function more effectively, its members will be healthier and happier. I
assume that it is both possible and important to improve health status. Health disparities in
our society are a social injustice and, as a citizen, I share with others a responsibility to
redress such injustice. The study is consistent with my social policy interests.
Professional and personal experiences have contributed to the perspective brought to
this research. In my professional life, I started as a nurse working in the community health
field, moved into community development and then health policy work and am now
coordinating primary health care transition activity as an employee of the Government of
Yukon Department of Health and Social Services. I have lived in the Yukon for the better
part of three decades and, throughout that time, have held a keen interest in health issues
affecting Yukon people. My experience both informs and limits my ability to understand
health issues. Embedded, as I am, in a life of positional power arising from relative
affluence, education, professional and employment status, I assume that there is much that is
within my control with respect to the determinants of my own health. With this fairly strong
sense of personal power, I may be limited in my ability to understand the perspective of those
with less experience of empowerment. However, I have also had personal experiences from
which I have learned much about the limits of my power; these situations have taught me to

cope with what I can control when much is spinning out of control in my world. As I have
learned to find my own answers in such situations, I have also come to recognize and respect
the need for and value of finding one’s own solutions to life’s dilemmas. My philosophical
and practical interest in capacity building approaches arises from my range of life experience.
In delineating the perspective that I bring to this project, it is relevant to define my
understanding of health. The definition most congruent with my own experience and
thinking is that health is the “capacity of people to adapt to, respond to, or control life’s
challenges and changes” (Frankish, Green, Ratner, Chomik & Larsen, 1996, Background
section, para 5). The World Health Organization definition of health, by comparison, states
that health “is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity” (1946). The World Health Organization definition aims for
an ideal that is unachievable, whereas my understanding of health is that it can be accessible
despite disability, disease or distress, reflecting an ability or capacity to cope with physical,
mental and/or social adversity. Although the World Health Organization definition has
remained extant over time, the organization has recognized in their health promotion
literature that to achieve the state of health, an individual or group must be able to identify
and realize aspirations, satisfy needs and change or cope with their environment (World
Health Organization, 1986). In addition, the Bangkok Charter for Health Promotion (World
Health Organization, 2005) offers a concept of health as a “determinant of the quality of life
and encompassing mental and spiritual well-being.” (p. 1). The health promotion focus taken
by the World Health Organization (1986) emphasizes the ability to respond to life
circumstances, as does the definition of Frankish et al. (1996). However, the World Health
Organization perceives the response to life challenges as a route to a state of complete well­

being rather than a manifestation of health in it’s own right. In eontrast, Frankish et al.
(1996) indieate that abilities in adapting, coping and responding to life challenges define
health, such that it could be accessible to people affected by disease or disability. I prefer the
Frankish et al. (1996) definition because it enables an understanding of health on both
individual and collective levels that respects that health can be achieved in the face of
circumstances that are less than ideal and in which we can each take an active role.
It is from the perspective framed by my views as a community health practitioner, my
experience and observations in professional and personal life and my understanding of health
that I have approached this research project.
Purpose
The purpose of the study is to gain an understanding of capacity building process and
outcomes within the Yukon context. Research on capacity building has not previously
focused on experience in a northern Canadian context, including the Yukon.
Within the main purpose of the study, there are several components. These
components include attention to the context of the Yukon and to differences within the
Yukon experience, as well as examination of the concept of community capacity and
indicators of such capacity. The components within the purpose are discussed here.
The study pays specific attention to the context of the Yukon with respect to capacity
building. The Yukon as a northern context shares characteristics with rural communities
such as geographically distinct locations, small populations and limited infrastructure as
identified by Smith et al. (2003), but is also distinct in a number of ways. Distinctions
between the Yukon context and other rural communities include the relative isolation of

spatial communities and the complex political environment, faetors expected to influence
contextual knowledge about capacity building.
The Yukon is not a homogeneous environment. Therefore, the study also seeks to
understand capacity building in Yukon, with attention to differences that arise within
experience in this eontext. Differences in size of communities, employment and education
opportunities and culture/ethnicity all give rise to differences in the experience of living in
the north. Research in a variety of settings in the Yukon illuminates such differences.
In order to understand eapaeity building, there is a need to examine the coneept of
eommunity eapaeity, a term often linked in literature with the concept of capacity building
(Bopp et al., 2000; World Health Organization, 1997). Rural settings are considered to be
promising settings in whieh to advance knowledge about community capacity (Smith et al.,
2003). To the extent that there are similarities between rural and northern experience, the
north is also a promising setting in which to advance such knowledge. There is growing
interest in developing indicators to evaluate or measure eommunity eapaeity (GermAnn &
Smith, 1999; Gibbon, Labonte, & Laverack, 2002; Hawe et al., 2000). Community eapaeity
indicators are thought to be useful for assessing the ability of community members to work
together on health determinants (Smith et al., 2003) and to determine whether eapaeity
building is effeetive in contributing to improved population health outeomes over time
(Taylor & Soal, 2003). This study sheds light on the links among eommunity capacity and
indicators of community capacity, in relation to Yukon experienee of eapaeity building.
Research Question
The researeh question to be explored was articulated as: what is the meaning and
experience of eapaeity building for health education workers in the Yukon context?

Knowing that the Yukon College Public Health and Safety unit identifies itself as taking a
capacity building approaeh, the people working in the unit can be considered to be a group
from whom much can be learned about capacity building in the Yukon. Workers with the
unit have the knowledge that makes it possible to learn about the process and outcomes of
capacity building in the Yukon eontext.
Conclusion
The study addresses the question by exploring literature on capacity building,
undertaking qualitative research with health education workers to answer the question and
reporting the findings from that research. The findings are discussed in relation to the new
knowledge gained and in relation to existing literature. Key themes emerging from the
Yukon study are identified, with discussion of concomitant implications for researeh, policy
and practice. The understandings gained about capacity building practice and health
workers’ roles in this eontext may be of value in addressing health inequities in and beyond
the Yukon.

10

CHAPTER TWO
Literature Review

This literature review outlines the social theory premises for the study, previous
researeh on capacity building and related concepts. Social theory is explored to situate the
study within a philosophical frame of reference. Meaning, process and outcomes of capacity
building are reviewed in order to understand the work that has preceded this study and to
frame the researeh methodology in light of that knowledge. Concepts related to capacity
building are reviewed in order to situate the study design within the body of related thought
on population health, socioeconomic influences on health status, social capital and
community resiliency. The review of literature provides a foundation from which further
knowledge of capacity building can be gained.
Social Theory
The social theory foundation for this study has been informed primarily by the work
of Charles Taylor and Anthony Giddens. Giddens (1993) endeavours to offer a unified
approaeh to social theory acknowledges different frames of meaning as the starting-point of
analysis. He takes the view that the production of society is brought about by the active
constituting skills of its members in interaction that involves (attempted) communication and
the operation of both power and moral relations. He holds that structure occurs as a
condition of interaction and as a consequence of it, a concept he describes as ‘duality of
structure’ (Giddens, 1993). He incorporates the empirical-analytic perspective into a frame
of meaning by noting that enquiry is relative to interests that stimulate the enquiry and to the
extent of knowledge already possessed by the enquirer, both of which arise from interaction.

11

Giddens sees power as integral to action and interaction. In his words, “action intrinsically
involves the application of ‘means’ to achieve outcomes...power represents the capacity of
the agent to mobilize resources to constitute those ‘means’” (p. 116). Although, this is an
extreme simplification of the ideas put forward by Giddens, the intent is to show his
integration of understanding different ways of being within a coherent framework. In
essence, interaction, including the exercise of power, is the foundation of our ways of being
in relation to each other, with structure occurring as both a means and an end to this
interaction.
Taylor (1991) puts forward the idea that society suffers from malaise arising from
individualism, the primacy of instrumental reason and the consequences of these for political
life in terms of alienation from public life and consequential loss of political control. He
makes the case that there are moral ideals that we ought to desire, although they have become
debased or trivialized in their expression.
Behind the malaise of individualism is the moral ideal of being true to oneself or
'authenticity', in Taylor’s view. This authenticity does not occur in isolation, but against a
horizon of significance that is independent of individual will and that arises from interaction.
He argues that this connection to a wider whole is something that we need to recover, in part,
through dialogue which both ties us to others and provides a background of intelligibility
against which things take on importance and which enables us to define ourselves. The
dialogue to which he refers is part of the process by which construction of social reality
occurs (Taylor, 1991). In other words, recovery of authenticity will counter the malaise of
individualism through dialogue that places us in interactive relationship with others and
within a wider context of intelligibility or significance.

12

Taylor describes the second malaise of modernity as the primacy of instrumental
reason. By instrumental reason, he means the kind of rationality we draw on when we
calculate the most economical application of means to a given end, leading to emphasis on
cost and efficiency above other criteria. Though it has lost sight of its moral sources,
instrumental reason has arisen from the moral ideals of rationality, that is, self-responsible,
self-controlling reason, and benevolence, with respect to improving the conditions of life and
relieving suffering (Taylor, 1991). Instrumental reasoning is reflected in positivist and post­
positivist assumptions. Taylor proposes that the moral ideals of instrumental rationality
provide the foundation for enframing it within an ethic of caring rather than one of control or
dominance over nature. Instrumental reason has benefit provided that it is applied in service
of people rather than in control over them.
Taylor’s third area of malaise is with respect to political life, where our challenge is
to:
combine in some non-self-stultifying fashion a number of ways of operating, which
are jointly necessary to a free and prosperous society but which also tend to impede
each other: market allocations, state planning, collective provision for need, the
defence of individual rights and effective democratic initiative and control (1991, p.
110).
The consequence of weakening democratic initiative is fragmentation, as we become
"increasingly less capable of forming a common purpose and carrying it out" (p.l 12).
Fragmentation grows to the extent that people no longer identify with their political
community and by the experience of political powerlessness. However, Taylor believes that
the vicious circle of fragmentation and powerlessness has potential to be a virtuous circle
(p.l 18). Successful common action can bring a sense of empowerment and also strengthen
identification with the political community. A vigorous democratic life, engaged in a project

13

of re-enframing could also have a positive impact on the atomistic and instrumental stances
generating shallow modes of authenticity (Taylor, 1991).

Taylor holds a lamp that enables

us to see the strength of the ideals behind societal malaise that offers an encouraging
perspective on the potential within society to achieve ‘grandeur’. This prospect of achieving
such grandeur is enticing.
Together, Giddens (1993) and Taylor (1991) offer a way of being grounded in
interaction, that both ties us to other people and provides a broader background of
intelligibility or horizon of significance against which to strive to achieve authenticity. The
exercise of power is an element of all interaction, one that includes but is not limited to
control over others; it is the means by which resources are mobilized to achieve ends.
Striving for personal authenticity, within an ethical framework of benevolence or caring for
others can provide the basis for effectively dealing with the tensions within our society and
for moving into successful common action. The discussion of capacity building will be
undertaken in relation to the theoretical stances articulated by Giddens and Taylor.
Meaning o f capacity building
Definitions of capacity building, the thinking behind the approach, and the
relationship of capacity building to health promotion are discussed under this heading.
Definitions o f capacity building
Despite the volume of literature about capacity building, there are relatively few
definitions. Smith et al. (2001) define it as “a process of working with a community to
determine what its needs and strengths are, and to develop ways of using those strengths to
meet those needs” (p. 31). Hawe et al. (1997) describe what capacity building does, how it
does it, and why it has value, rather than defining the term. An action-oriented focus is

14

apparent in their description that what capacity-building does is “deliver(s) health gains not
only in association with the health problem of interest, but also on a wider front as a result of
the problem-solving focus of the multiplier effect”(p.38). By this, I understand Hawe et al. to
mean that problem-solving that enables health gains in one area contributes to gains in other
areas. Hawe et al. describe how capacity building delivers health gains by “building
sustainable skills, resources and commitments to health promotion in health care settings,
community settings and in other sectors, (that) health promotion workers prolong and
multiply health gains many times over”(Hawe et al., 2000, p.2). Multiplying health gains is
the reason why capacity building has value. Multiplying health gains is crucial to extending
competence to address not only the health problem of current interest, but also other health
issues (Hawe et al., 1997). There is interest in capacity building within disciplines other than
health, including social work (Poole, 1997), environmental protection and management
(Gomez Gonzalez Cosio, 1998) and resource management (Mendis & Reed, 2003).
Common to capacity building in all disciplines is the process of developing ability to identify
and solve problems. Definitions consistently build on the values of interactive relationships
and on empowerment through collective action. Community or collective action is implicit
in all the definitions, as is a strengths-based approach to identifying issues and solving
problems.
Labonte and Laverack (2001a) indicate that capacity building has both constitutive
elements, ends in themselves, and instrumental ones, that is, means to an end. Rather than
attempting to resolve this dialectic, they choose to take a path recognizing the confluence of
these ideas. Thus, they identify as capacity, those “elements of peoples’ day-to-day
relationships, conditioned and constrained by economic and political practices, that are

15

important determinants of the quality of their lives, if not also of communities’ healthy
functioning” (p.l 12). Thus, an understanding of capacity building incorporates the ideas that
it is both a means, or a process, and an end that achieves a purpose such as achieving health
gains or meeting needs. Labonte and Laverack call attention to the link between individual
and community health, a link found to be relevant in this study.
Community capacity and capacity building are closely associated terms. Bopp et al.
(2000) define community capacity to mean “the ability of people and communities to do the
work needed in order to address the determinants of health for those people in that place”
(p. 14). Smith et al. define it as “the degree to which a community can develop, implement
and sustain actions for strengthening community health” (p.33). Common to all definitions
of community capacity is a focus on processes of action and relationship to effect change
towards the end of improved health in communities. There is considerable overlap between
the terms community capacity and capacity building.
Labonte and Laverack (2001a) focus their work particularly on community capacity
building. They describe community capacity building as an “increase in community groups’
abilities to define, assess, analyze and act on health (or any other) concerns of importance to
their members” (p. 114). Labonte, Bell Woodard, Chad & Laverack (2002) say that
“community capacity-building, like the related concepts of community development and
empowerment, is about increasing the capabilities of people to articulate and address
community health issues and to overcome barriers to achieve improved outcomes in the
quality of their life” (p. 181).
Like capacity building, community capacity building is understood to constitute both
means and ends. Kwan, Frankish, Quantz & Flores (2003) state, “Although a program may

16

include the building of community capacity as an objective (an end), community capacity is
more often thought of as a means to better quality of life and healthier communities” (p. 45).
They see community capacity building as a process that is re-iterative and cyclical with no
actual end because communities are not static entities. Both constitutive and instrumental
elements of community capacity building are seen to have relevance in this study.
This is a point at which it is useful to clarify the definition of community. A
community is understood to mean “specific groups and networks of groups organizing
around specific issues, generally but not always spatially bound” (Labonte & Laverack,
2001a, p. 116). Spatial communities have geographical boundaries, which may overlap, and
people may live in and have an affinity for multiple spatial communities at a given time.
Non-spatial communities are based on affinity, for instance with racial or professional
groups, rather than geography and may transcend, overlap with and/or be contained within
spatial boundaries (Frankish, Kwan and Flores, 2002). It is argued that there is no sound
reason for excluding either spatial or non-spatial communities from the study of community
capacity (Kwan et al., 2003). In this study, communities are considered to include both
spatial geographic communities and non-spatial communities of interest within the Yukon
context.
Capacity building definitions commonly include reference to a process of working
with people in communities, achieving health gains and to increasing capabilities among
people to address health issues. Terms closely related to capacity building are community
capacity building and community capacity. In light of the emphasis on community, a
definition of that term is also relevant. The definitions point to the need for further
exploration of the process and outcomes of capacity building activity. First, the thinking

17

behind capacity building is explored and set in context with health promotion concepts.
Thinking behind capacity building
The thinking behind capacity building has arisen from a number of sources. Ivan
Illich (1976) held that the level of health corresponds to the degree to which the means and
responsibility for coping with illness are distributed among the total population. He
considered that the ability to cope, or process of adaptation, can be enhanced but never
replaced by medical intervention or by the hygienic characteristics of the environment. The
relationship of empowerment and participation with health promotion, and with capacity
building as part of the health promotion tradition, is recognized as being fundamental to good
health (Hancock, Labonte, & Edwards, 1999). Other authors have identified that building
capacity from the strengths found in a community is an approach to asset-based community
development that provides an alternative to a problem-focused approach. (Kretzmann &
McKnight, 1993; Restrepo, 2000). Arising from thinking about empowerment and assetbased community development, the idea is emerging that health can be improved by
supporting community-level activity. Collective or community level activity is seen as an
effective means to address health inequities. Capacity building offers an approach that can
enable such collective activity to occur.
Capacity building as an approach to health promotion
Exploration of the concept and practice of capacity building in relation to achieving
improved health outcomes is frequently found in health promotion literature. Capacity
building is an approach to health promotion. There is not full agreement on how health
promotion is best approached. Laverack and Labonte (2000) have identified two different
health promotion discourses, one espousing a top-down disease prevention/lifestyle change

18

approach, the other a bottom-up community empowerment approach. The disease
prevention/lifestyle management approach emphasizes individual responsibility, is oriented
to solving problems defined by an outside agent, through education or improved services.
Outside agents deliver services and act as the primary decision makers. There is low
community control of resources or ownership. Evaluation is undertaken in relation to the
specific risk factors and quantifiable outcomes (Laverack & Labonte, 2000). Having some
understanding of these two discourses enables an understanding that capacity building is
most closely aligned with an empowerment approach to health promotion.
The empowerment approaeh to health promotion is gaining ascendaney, as indieated
by a number of sources. For instance, the World Health Organization defined health
promotion as “the process of enabling people to increase control over, and to improve, their
health” (World Health Organization, 1986, p. 1). The guiding principles of action, as well as
the means of action articulated in the Ottawa Charter for Health Promotion focus on
collective aetion directed to improvement of individual and eollective health eonditions
(Erben, Franzkowiak, & Wenzel, 2000; World Health Organization, 1986). The Jakarta
Declaration claimed that health promotion has an impact on determinants of health, health
inequities, human rights and the building of social capital (World Health Organization,
1997). The Declaration also included the priority to “inerease community capacity and
empower the individual” (p.2). GermAnn and Smith (1999) align capaeity building elearly
with the empowerment approach. They argue that capaeity building is not a program, but a
philosophy and praetiee “based on the values of empowerment, equity, and social justice” (p.
3). The literature indicates that capacity building is an approach to health promotion

19

consistent with an empowerment approach and having potential to address the determinants
of health.
Capacity building clearly has a place in the realm of health promotion. The question
that arises is how a capacity building empowerment approach can be incorporated within
programs that do not have this explicit intent. The Yukon College Public Health and Safety
(YCPHS) Unit, with its capacity building approach to all activities, including health
promotion, first aid instruction and ambulance attendant training, is focused more explicitly
on capacity building than on health promotion. As most prospective participants are
involved in teaching first aid, the emphasis is on health education. The YCPHS Unit
provides an interesting setting in which to explore the health promotion influences achieved
by taking a capacity building approach to health education. We know little about the
attitudes, working practices and skill sets that are used in putting the capacity building
approach into practice.
Summary
The connection between empowerment and capacity building has been clearly
demonstrated in the literature reviewed. Conceptually, capacity building has the potential to
address the malaises of modernity identified by Taylor (1991), by reducing our atomism and
increasing our ability to act collectively towards a common purpose. The potential benefits
of acting collectively to a common end form the foundation for the belief that health gains
can be multiplied by a capacity building approach. In health and other sectors, work in
capacity building is being undertaken in the belief that this is the route to developing ability
to identify and solve problems, building on the values of interactive relationships at a number
of levels and on empowerment through collective action. The literature review of capacity

20

building, thus far, contributes to an understanding of the meaning of the term. The
subsequent section shall explore the process of capacity building.
Process o f Capacity Building
In order to understand the process of capacity building, literature has been reviewed
with respect to approaches, purposes, activities and actors. Approaches to the process are
seen as multi-faceted or as occurring along a continuum. Activities occur at multiple levels.
Actors include agencies, practitioners and community members, each with different
purposes. In examining the process of capacity building, the interrelationships among the
approaches, activities, actors and purposes involved in the capacity building process are
shown and the pivotal importance of the health promotion worker identified.
Approaches to capacity building
The bottom-up empowerment approach to health promotion builds strength and
capacity to address problems identified by the community through building community
control, resources and capacities. (Laverack & Labonte, 2000). Outside agents respond to the
needs of the community, whose members are the primary decision makers. Community
control of resources and ownership is high and evaluation is undertaken by documenting
changes of importance to the community (Laverack & Labonte). Capacity building is
consistent with bottom-up programming whereby “the outside agents act to support the
community in the identification of issues which are important and relevant to their lives, and
enable them to develop strategies to resolve these issues” (Laverack & Labonte, p. 256).
Although the top-down and bottom-up approaches identified by Laverack and
Labonte (2000) are not necessarily mutually exclusive in practice, it can be difficult to
accommodate both. Parallel program and empowerment tracks are suggested as one way to

21

accommodate the goals of both approaches (Labonte et ah, 2002; Laverack & Labonte). In
practice, this involves working to link programs with a particular risk factor focus with a
capacity building approach, by intentionally seeking to enhance capacity domains (Gibbon et
ah, 2002).
Hawe et ah (2000) present capacity building as a continuum of activities that cross
both the top-down and bottom-up approaches described by Laverack and Labonte (2000).
Research conducted by Hawe, King, Noort, Gifford & Lloyd (1998) points to the challenge
of accommodating both risk-factor and empowerment approaches to health promotion. They
described capacity building, an empowerment approach, as a hidden activity within health
promotion work. The perspective of Hawe et ah (1998) is consistent with the idea of
community capacity building as a parallel track to other health promotion programming
activity.
GermAnn and Smith (1999), on the other hand, position themselves as favouring an
empowerment process approach. They call for “attitudes, working practices and professional
skill sets that differ from those which have dominated traditional models of health service
delivery” (p.3). This approach would require a philosophical shift in the approach to health
promotion that is more transformative than the parallel-track or continuum approaches. It is
also an approach that is less likely to be adopted as it would require a reorientation of health
systems that is unlikely to occur (Gibbon et al., 2002).
The process of capacity building can also be understood as embodying four different
approaches (Crisp, Swerissen, & Duckett, 2000). Though identified separately, the
approaches are not necessarily exclusive. Crisp et al. identify these as a top-down
organizational approach, a bottom-up organizational approach, a partnerships approach and a

22

community organizing approach. The top-down organizational approach involves struetural,
resouree, policy and practice eommitments to support capacity building. The bottom-up
organizational approaeh is summed up as being most effective when there is commitment
within an organization to continuous learning and improvement. Partnerships among or
within organizations that might not otherwise have a working relationship is another way of
building capacity. The assumption behind this approaeh is that health promotion efforts ean
be optimized through such relationships. The community organizing approach involves
working with communities, especially the most disenfranchised members, to solve health
issues. The complexity of this approach is acknowledged. While sueeesses are cited in their
work, potential shortcomings include the development of unrealistic community expectations
and the need for resources of time, skill and commitment, resources that are least likely to be
available among the disenfranchised (Crisp et al.).
Activities o f capacity building
Hawe et al. (2000) begin to address this question of how to work together by defining
at least three activities of capacity building. These activities are building infrastrueture for
health promotion program delivery, building partnerships and organizational environments so
that programs and health gains are sustained and building problem-solving eapability. The
first level, building infrastructure, involves elements such as planning and evaluation, skills
required to enable program delivery. Capacity building of infrastructure has derived mainly
from the interest in ensuring loeal ability to address health priorities set elsewhere, including
such priorities as cancer control and cardiovascular disease prevention. The second level
involves developing networks to maintain programs beyond a limited funding period. The
third level, problem-solving capacity, moves into the realm of addressing the risk eonditions

23

that affect health status. It is particularly at this level that inequities in health are likely to be
addressed (Hawe et ah). The potential to improve the ability to address health inequities
makes the process of capacity building an exciting area of study.
To understand the process of working within a community, the ideas of levels or
eontinuums of capacity building activity are useful. Hawe et al. (1998) identify five
different levels or aspects of capacity building activity; these are individual, within health
care teams or groups, within organizations, across organizations, and within communities.
These levels correspond with the community empowerment process which proceeds along a
continuum involving personal empowerment, development of small mutual groups,
community organizations, partnerships and social and political action (Laverack, 2001). The
concept of multiple levels or a continuum of capacity building activities provides a link
between the terms capacity building and community capacity building by emphasizing that
capacity building includes eommunity level action and that community capacity building
encompasses individual-level activity. In order to understand the meaning of capacity
building toward community empowerment, it is useful to recognize that the activity occurs
on a continuum from individual to collective levels of action.
Actors and their purposes in capacity building
Labonte and Laverack (2001) identify three actors in health promotion capacitybuilding relationships; these are government or non-government health agencies, health
promotion practitioners and community groups/members. The purpose of capacity building is
somewhat different from each of these perspectives. The purposes of capacity building for
the respective actors described by Labonte and Laverack correspond closely to the activities
described by Hawe et al. (2000). For health agencies, the purpose of capaeity building is for

24

program delivery and for supporting relationships with health promoters and community
groups. This purpose corresponds with Hawe et al.’s activity of building infrastructure for
health promotion program delivery. For health promoters, the purpose is to build program
sustainability and develop relationships with community groups, corresponding to the
activity of building partnerships and sustainability articulated by Hawe et al. For community
groups and members, the purpose is to sustain programs and to develop generic qualities of
healthy functioning, corresponding to the problem-solving activities of Hawe et al. The work
of Labonte and Laverack begins to clarify the relationships that are involved in capacity
building activities or processes.
Summary
The processes at play in capacity building activity include an array of approaches,
activities and actors, with different purposes and approaches at work in relationships among
the actors. The pivotal role of the health promotion practitioner as the link between the
community and the health agency has emerged in this exploration of capacity building
process. The health promotion practitioner has roles in supporting the development of
partnerships and community organization, sustaining programs and relating to the health
agency. However, it is the extent to which health promotion practitioners move from a focus
on program maintenance and sustainability to focus on developing problem solving
capability of community members and groups that they empower those community members
to develop their capacity for healthy functioning (Hawe et al., 2000). Other writers take the
view that practitioners cannot empower others, but that empowerment can be facilitated
through an enabling process (GermAnn & Smith, 1999; W orld Health Organization, 1986).
At the time that Hawe et al. first examined capacity building in 1997, it was a relatively new

25

concept. Since then, the term has moved into common usage in health and a wide range of
other areas (Kwan et al., 2003), but it is not clear what approaches, or activities are now
encompassed in capacity building practice. Exploring the experience of health promotion
practitioners enables us to gain insight from their practice knowledge.
Outcomes o f Capacity Building
Rationale fo r examining outcomes
Taylor (1991) advises that instrumental reason is of benefit when applied to
improving the conditions of life and relieving suffering. Considerable work has been done to
understand capacity building, community capacity and capacity in order to be able to assess
whether capacity building is an approach that achieves health gains, as its supporters claim it
will. Since it is argued that capacity building is instrumental to multiplying health gains,
there is seen to be need to measure both health gains and capacity building (Hawe et al.,
1997). As capacity building moves towards creating problem-solving capability, control
over the nature of the health issue addressed is relinquished by the health system (Hawe et al,
2000, p. 8). Although capacity building proponents argue that this will undoubtedly bring
wide gains, it is anticipated that measurable gains at the population level will occur over the
long term and that there is need for outcome indicators of the process itself (Hawe et al.,
2000). Most agencies and funders have mandates and objectives for which they need to be
accountable (Gibbon et al., 2002). As Smith et al. (2003) note, “accountability issues are
fundamental here” (p. 25). While outcome measurement is relevant to accountability for
capacity building approaches, the validity of such measurement is its grounding within the
practice context or situation (Hawe et al., 2000; Smith et al., 2003). Outcome evidence is

26

required if community capacity building is to have credibility and support over the long run.
Grounding such evidence in the Yukon context is needed to ensure validity.
There are a number of reasons for gathering evidence of the outcomes of capacity
building. These reasons include the need for understanding the effectiveness of capacity
building process and outcomes (Hawe et al., 2000), for informing practice (Bopp et al., 2000)
and for situating practice within an empowerment philosophy (Smith et al., 2001). The
philosophy and practice of capacity building emphasize working on health issues identified
by community members rather than on those identified by health professionals (Smith et al.,
2001). This means that measures of effectiveness must be specific to the community, as is
the definition of the problem and the solution (Bopp et al., 2000, Laverack and Labonte,
2000). Bopp et al. argue that methodology to research effectiveness will be characterized by
use of both qualitative and quantitative data and by accommodating both process and
outcome measures. These are compelling reasons for examining capacity building outcomes.
Assessment processes can point the way for learning and action needed for the
community and can guide work done by health promoters. As such, they constitute “a form
of critical reflection for future stages of community work” (Bopp et al., 2000, p. 15).
Although the pressure to measure effectiveness of capacity building feeds “the outcome
fetish” (Bopp et al, p .11), the approach to doing so can apply instrumental reason in the
service of people rather than in control over them, as Taylor (1991) would recommend.
Domains and indicators
Domains of community capacity and indicators of capacity building have been
developed in an effort to gain understanding of process and outcomes of capacity building
practice that may be measurable before health outcomes in disease and morbidity incidence

27

have changed. These domains and indicators are discussed here, followed by a summary of
the points of debate with respect to measurement issues.
Domains of community capacity are understood as the “qualities of a capable
community” (Labonte & Laverack, 2001, p. 116). Several groups have undertaken to
identify such domains. (Bopp et al., 2000, Kwan et al., 2003, Labonte & Laverack, 2001).
As Labonte and Laverack note, “there is no definitive set of characteristics that describe a
capable community; but neither do such capabilities vary infinitely by each community or
situation” (p. 117). Consistent with that observation, there are substantial overlaps among
domains identified by different groups.
Labonte and Laverack (2001) identify nine domains of community capacity:
participation, leadership, organizational structures, problem assessment, resource
mobilization, ‘asking why’, links with others, role of outside agents and program
management. Their domains were subjected to theoretical and face validity tests as well as
field trials, though they make no claim that this is a “’true’, or even ‘best practice’ template”
(p. 117). Domains identified by Labonte and Laverack are not situated in a particular
context, they are aspatial.
Bopp et al. (2000) identify seven domains: shared vision, sense of community,
participation, leadership, resources, knowledge and skills, communication and ongoing
learning. The domains were developed in stages that included literature review, participatory
action with rural communities and reflection on the literature, process and findings. Their
domains are grounded in both theoretical and community experience.
Hawe et al. (2000) identified indicators of capacity building, rather than domains of
community capacity. Hawe et al.’s nine indicators are: strength of coalition, opportunities to

28

promote incidental learning among other health workers, opportunities to promote informal
learning among other health workers, program likely to be sustained, learning environment of
a team or project group, capacity for organizational learning, capacity for an organization to
tackle a health issue, quality of program planning, and eommunity capacity to address
eommunity issues. Although there is overlap with community capaeity domains identified by
Labonte & Laverack (2001) and Bopp et al. (2000), Hawe et al.’s indicators are linked more
with the process of capacity building than with eommunity capaeity.
Kwan et al. (2003) identify three levels of community capacity: individual,
organizational and eommunity. The individual level includes characteristics of people as
individuals, such as personal attitudes, knowledge, skills and practices or behaviour. The
organizational level involves characteristics referring to formal organizations or agencies,
including how organizations function and the environment in which they function.
Community level characteristics are broader than individuals or single organizations and
include “informal and formal networks between organizations and between individuals and
organizations in the eommunity, the infrastructure within the eommunity, and the networks
and resources from outside (external) to the eommunity” (Kwan et al., p. 17). Kwan et al.
note the challenges in achieving consensus on what community capaeity is, on finding valid
and reliable measures of eommunity capacity and of reflecting the collective element of
community capacity that is more than a sum of individual measures. Although the effort
involved in understanding and measuring community capacity may have value in
determining over time whether capacity building is effective, it is likely that there will always
be limits in attempts to find objective measures of a dynamic process.

29

Debate occurs with respect to the range of events that are considered health outcomes.
Some programs have the goal of reducing mortality and morbidity while others see endpoints
in relation to change in health risk behaviours, environmental hazards or public policy,
considered to be intermediate indicators on the path to changed disease incidence (Hawe et
al., 2000). There is debate about the extent to which intermediate indicators can be used to
define endpoints of health promotion programs, the extent to which health in a positive sense
ean be measured as an outcome of health promotion, the limitations of evidence of
effectiveness for disadvantaged and minority groups and whether empowerment is a process
or dimension of health (Hawe et al., 2000). This debate about health outcomes occurs before
beginning to talk about the measurement of community capacity or capacity building activity.
Within discussion of community capacity, there is debate about how to determine rank of
different domains, who determines it and how it is validated (Bopp et al., 2000; Labonte &
Laverack, 2001b). For instance, how is it decided whether there is high or low community
participation, by whom is it decided and ean the rank be confirmed among different
assessors? It is important to articulate the main points of debate within the discussion of
capacity building, so that findings from the Yukon study can be understood within this
framework. The debates will not be resolved through the proposed study.
Summary
A point of frequent agreement among the groups that have developed community
capacity domains or capacity building indicators is the need for communities to have the
flexibility to translate capacity building outcomes into their own terms; one size will not fit
all communities (Hawe et al., 2000; Labonte & Laverack, 2001; Smith et al., 2003). To
Smith et al.’s argument for the value of distinguishing between urban and rural settings, I add

30

the argument for the value of further distinguishing northern settings. In addition to the
geographically distinct locations, small populations and limited infrastructure characteristic
of rural communities, the Yukon setting is characterized hy greater spatial isolation of
geographic communities and a complex political environment, differences that may
contribute unique understanding to the knowledge of capacity building practice.
Concepts related to capacity building
Determinants o f health
A number of factors are known to influence and contribute to health. These factors,
commonly called the determinants of health, include social, physical and economic
environments, early childhood development, personal health practices, individual capacity
and coping skills, human biology and health services (Chomik, 2001, p. 11). Chomik further
defines socioeconomic environments to include the factors of income, income distribution
and social status, social support networks, education, employment and working conditions
and social environments (p. 12). Determinants of health include individual choices, such as
smoking and exercise. Beyond individual choice, thinking on determinants of health
recognizes that there are social structural influences on health outcomes, which arise from
domains of influence beyond the individual (Dunn & Hayes, 1999).
Population health
To the extent that community capacity building is effective in acting on determinants
of health, it is linked to population health concepts. Population health refers to the health of a
population as measured by health status indicators and is a concept that incorporates
recognition of the influence of determinants of health. Population health is an approach that
focuses on the interrelated conditions and factors in the environment that influence the health

31

of populations, and advocates taking action that will reduce inequities that put some at a
disadvantage in attaining and maintaining optimal health (Federal, Provincial and Territorial
Advisory Committee on Population Health, 1999, p. 7).
Health equity
Pursuing equity in health means eliminating health disparities associated with social
disadvantage or marginalization (WHO Task Force on Research Priorities for Equity in
Health, and the WHO Equity Team, 2005). The unequal distribution of the social and
economic determinants of health presents a challenge to reducing health inequity. Health
inequity is reflected in health status that has been shown to occur along a gradient that
remains extant in relation to socioeconomic status across time, place and specific causality
(Mustard & Frank, 1994). A growing body of research on the economic aspect of this
gradient supports the idea that it is relative, rather than absolute, income inequality that is
associated with health disparities. (Dunn, 2002; Kawachi & Kennedy, 1997; Wilkinson,
1999) Thus, it is wide income disparities within a population that contribute to health
disparities rather than inability to meet the basic needs of life. It is argued that it is
psychosocial influences as much or more than economic ones that are relevant in
understanding the health gradient (Blakely & Kawachi, 2002; Veenstra, 2001; Wilkinson,
1999; Wilkinson & Marmot, 2003). This argument holds that there are psychosocial
pathways associated with relative disadvantage that act in addition to the direct effects of
absolute material living standards. (House, Landis & Umberson, 1988; Wilkinson &
Marmot, 2003). While recognizing the importance of the psychosocial environment, it is
difficult to separate economic from psychosocial influences. For instance, both low income
and social exclusion have been identified as contributing to heart disease (Raphael, 2001).

32

A focus only on psychosocial influences could contribute to victim blaming at the
community level and counter movement towards structural change (Lynch, Davey Smith,
Kaplan & House, 2000). Exploring capacity building as an approach that has potential to
influence determinants of health may provide insight into a way to reduce health disparity
and improve health equity in the Yukon and elsewhere.
Social capital
Social capital is a concept related to capacity building and population health. There is
a growing, though not conclusive, body of thought that population health could be improved
through development of social capital and social cohesion by influencing norms and
strengthening bonds of civil society (Krieger, 2001). Though there is debate about the
definition of social capital, consensus is beginning to emerge that the term refers to norms,
values and networks that facilitate collective action. (Cote, 2001; Putnam, 1995; Woolcock,
2001) Lomas (1998) posits that there are potential benefits to implementing and evaluating
community-level interventions rather than those interventions that attempt to modify
individual health behaviours. The concept of social capital as a route to improved population
health is criticized for emphasizing individual responsibility through social marketing rather
than collective social action through health promotion (Erben et ah, 2000) and for being a
vague term that risks misspecifying social phenomena (Earls & Carlson, 2001). Although
social capital is a concept linked to capacity building, it is less focused on application in
practice. It points to the importance of relationships, connecting in this way with the social
determinants of health and with the relational characteristics of capacity building.

33

Community resiliency
Community resiliency is defined as the ability of a community to respond to adversity
and, in so doing, reach a higher level of functioning (Kulig, 2000). According to Kulig,
“therefore, the community as a whole experiences health which in turn can lead to improved
health status among its residents” (p.375). Community resiliency is related to both the means
of capacity building through community level process and the end of aehieving a beneficial
impact on population health.
Summary
Concepts related to capacity building have been discussed to provide some sense of
the connection that exists between it and other areas of thought within and beyond the health
field. The intent has been to draw attention to the existence of the ideas, to indieate how they
are linked with capacity building and to articulate some of the debate within these realms,
particularly as such debate may relate to capacity building. This exercise helps to set
capacity building within a larger context within the health field.
Conclusion
The literature review establishes the conceptual foundation for the study, followed by
exploration of the meaning, process and outcomes of capacity building. Related concepts
have been diseussed. The review points to the value of exploring the meaning and
experience of eommunity building practice in the Yukon context, in the interests of
understanding how health outcomes might be improved through such practice in the Yukon
and elsewhere.

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CHAPTER THREE
Methodology

In order to study the experience of capacity building in the Yukon, research was
undertaken with the health education workers working with the Yukon College Public Health
and Safety unit. In this chapter, the study research method is explained, including discussion
of approach, setting, participant selection, conduct of interviews, data collection and analysis,
rigour and ethics.
Research Method
Approach to research design
The research was designed to apply a qualitative description approach (Sandelowski,
2000). Sandelowski describes this approach as categorical, less interpretive than interpretive
description and not requiring a conceptual or abstract rendering of data (p. 335). By
categorical, Sandelowski means that the method already exists, though it is relatively
unacknowledged. By interpretive description, she means that researchers are not required to
move as far from or into their data and by not requiring conceptual rendering of data,
recognizes that the product is complete and valued in itself. During data analysis, the
approach moved within the qualitative description approach to one of interpretive
description, becoming grounded in an orientation acknowledging the constructed and
contextual nature of experience, while allowing for shared realities (Thorne, Reimer Kirkham
& MacDonald-Emes, 1997). The reason for moving along the continuum of qualitative
description towards interpretive description was for the purpose of exploring to an ever
greater extent, the meanings and explanations that could have application in capacity-

35

building practice. (Thorne, Reimer Kirkham and O ’FIynn-Magee, 2004). The application of
this interpretive description approach is explained more completely in the data analysis
section. Thus, the study moved within the continuum of qualitative description from what
was originally expected to be thematic description to become interpretive explanation
(Sandelowski & Barroso, 2003).
The study design drew on a study conducted by Hawe et al. (1998) that explored the
meaning and experience of capacity building in a variety of health promotion practice
settings in Australia. In their study, six focus groups were conducted with health promotion
workers with the intent of finding “shared patterns and issues across the heterogeneity of
practice approaches” (p. 286). Like their Australian counterparts, Yukon participants were
asked about their understanding of the meaning of capacity building and their experience
with this practice, with respect to process, outcomes and issues. For reasons explained
below, after the first interview, Yukon participants were asked first about their work, the
process, outcomes, helps and hindrances and then about meaning in relation to capacity
building. As in the study conducted by Hawe et al., shared patterns and issues were sought
across a range of practice settings among a variety of practitioners.
Setting
The study was set in the Yukon, with participants selected from various communities
throughout the territory. The Public Health and Safety unit is located at Yukon College, in
Whitehorse, Yukon. The five employees of the unit are based in Whitehorse and have
responsibility for program delivery there and in communities outside Whitehorse. The
network of instructors who assist in program delivery included 86 people at the time of the

36

study. Network members generally live in the community in which they conduct programs.
Programs are offered in communities throughout the Yukon.
Participant selection
To address the research question, interviews were conducted with workers employed
in the Public Health and Safety unit at Yukon College (employees) and with some of the
people in Yukon communities who instruct programs for that unit (network members).
Together, the employees and network members are referred to as health education workers.
The rationale for choosing this group of health education workers is followed by an
explanation of how participants were selected.
There were several reasons for undertaking the research with the health education
workers associated with the Public Health and Safety unit at Yukon College. The reasons for
choosing this group included their knowledge about capacity building, my ability to
interview them free of conflict of interest, their experience across a range of settings within
the Yukon context, the ability to maintain confidentiality due to group size and their
willingness to participate.
All employees of the Yukon College Public Health and Safety unit were selected to
participate in the study. Network members were selected by choosing a sample from four
community size groupings. Community size groupings were identified as Whitehorse, large,
medium and small. (See Table 1) The majority of participants were selected from
Whitehorse, the main population center of the territory. The initial plan to choose one rural
community at random from each of the three size groupings was modified slightly, as
described below. When a rural community name was drawn, all network members in that
community were invited to participate in the interview. The intent of this selection strategy

37

was to obtain participation by workers practicing across a wide variety of settings to allow
for identification of common themes (Patton, 1990).
Table 1 Community by size grouping and population with number of network members
Community grouping

Community name

Community
population

Capital
Large (500-2000)

Whitehorse
Dawson City
Haines Junction
Watson Lake
Carcross
Carmacks
Faro
Marsh Lake
Mayo
Old Crow
Pelly Crossing
Ross River
Teslin
Beaver Creek
Burwash Landing
Destruction Bay
Tagish

22,425
1,788
790
1,551
414
409
345
279
395
265
285
344
417
109
75
57
186
30,255

Medium (200-499)

Small (<200)

Number of
network
members
60
5
3
3
1
-

3
1
3
1
2
-

1
1
1
1
-

86

Participants from Whitehorse other than the unit employees were selected by random
draw from a list of a total of 60 instructors. In soliciting participation, it became apparent
that contact by phone initially, even if only to leave a message, was more successful than
initial contact by email. From the total of 30 names drawn in Whitehorse, 10 instructors
were willing and able to be interviewed.
When a community name was drawn, all instmctors from that community were
contacted by phone, followed by an email. Due to confusion on my part, a participant that I
had thought lived in a small community actually lived and did most of his teaching in a

38

nearby medium sized community. Therefore, two medium sized communities are
represented in the study, rather than one, as had been planned initially.
Participants selected and consenting to interviews included the five employees of the
Yukon College Public Health and Safety unit, ten instructors from Whitehorse, two from a
large sized Yukon community, three from medium sized communities and one from a small
community. The participant selection process ensured that a wide range of community
experience would be represented in the study, and that the selection of prospective
participants was unbiased.
Conduct o f Interviews
A brief explanation about capacity building was provided by email to prospective
participants so that they would have some idea of what I wanted to discuss with them.
Although wording varied slightly, explanations were consistent with the sample provided
below, which was sent to potential participants in a community outside Whitehorse;
So that you know where I'm coming from, I understand capacity building as being the
indirect work done in developing and delivering programs. It may have effects in
addition to the particular focus of the health education activity. I think capacity
building is a process that can help to improve health outcomes in the Yukon and I am
interested in learning more about it for that reason. To that end, I would like to
interview you about your understanding of the meaning, process and outcomes of
capacity building in relation to your work with Public Health and Safety programs.
(Horton, J., June 2004)
My intent was to give some indication of the topic to be discussed, without being directive in
seeking a particular response.
Ten interviews were conducted with a total o f 21 people. Five o f the interviews were

conducted with individuals and five with groups ranging from two to five participants.
Interviews were conducted between June 7, 2004 and August 12, 2004. The period
during which interviews were conducted coincided with a heat wave, always an event of

39

some wonder in the Yukon, and one which influences other things in the environment. For
instance, the heat contributed to extreme fire hazard conditions and to forest fires throughout
the territory. In one interview, an active fire within a few kilometres of the participant’s
home was certainly on that person’s mind during the interview; in another instance, the
participant expressed fatigue from two weeks of involvement in enforcing a fire ban along a
fairly long stretch of highway. A number of participants who were also members of their
local volunteer ambulance services were involved in and affected by recent accidents in their
area, to which they made reference during their interviews. The summer period during which
interviews were conducted may have influenced the ability to recruit participants, and
certainly influenced the events that participants were dealing with in their lives.
Interviews were conducted in person where feasible, by videoconference as a second
choice, and by telephone if no other options were available. Seven interviews were
conducted in person, one by videoconference until a power failure in the community made it
necessary to switch to teleconference and two were conducted by telephone.
Data collection
Small group interviews were the preferred interviewing technique because of the
benefits of gaining perspectives from several people together and of acknowledging the team
aspect of practice by engaging the participants as a group (Hawe et al., 1998, Patton, 1990).
Individual interviews were conducted when there was only one person involved as an
instructor in a community or when an individual interview was most convenient for the
participant. Using both small group and individual interviews proved to be a practical
approach to learning about capacity building experience in a range of Yukon situations.

40

In both group and individual interviews, the intent was to ask participants to respond
from their experience to questions exploring the following themes, drawn from Hawe et al.
(1998):
1. The meaning of the term capacity-building
2. The process or steps in capacity-building
3. The outcomes of capacity-building
4. Facilitators, dilemmas and issues in conducting this style of work in the Yukon
Questions developed to guide the exploration of themes are provided in Appendix A.
Following feedback from, and reflection on, the first interview, 1 realized that asking
first about the meaning of capacity building was not comfortable for participants and, for one
person, led to the perception that 1 was looking for a particular response. To ensure greater
comfort for participants, and to reduce the potential for responses to be skewed by trying to
give me a particular response, 1 rearranged and refocused the questions to ask people about
what they did in their work with Yukon College Public Health and Safety unit, the process or
steps in that activity, the outcomes, the facilitators and hindrances to them in relation to the
activity and, finally, if and how they saw that as capacity building. This order of questioning
allowed people to move from describing their concrete activities to the observations that they
had made in relation to those activities and then to their reflections on the concept of capacity
building in relation to those activities. The interview questions thus moved from concrete to
abstract concepts in a flow that 1 perceived to be a logical one for the participants and, 1
believe, facilitated their comfortable involvement in the interview. This shifted the focus of
the interview such that participants discussed the process of outcomes of the activity in which
they were involved rather than the process or outcomes of capacity building as such. From

41

my perception, interviews subsequent to the first one appeared to be more comfortable for
participants, and for me. Findings reflect this shift in order and focus of the questions.
Participants consistently asked for an explanation or definition of capacity building
before or during the interview. Prior to or during each interview, I responded to the question
of what I meant by capacity building. The answer was not exactly the same in each case. An
example of a recorded answer is provided below:
Capacity building is something that I have got interested in because of its ability to
help people influence the determinants of health for themselves. So it’s something
that’s kind of an indirect consequence of some of the other kinds of health education
activities or health promotion activities quite often. And it’s because of that potential
that it has to really have the sort of ripple effect of these other benefits that I’m
interested in learning more about what happens when people like yourselves are
actually instructing a program or organizing for it or seeing the outcomes of it, so
that’s what I’m wanting to talk with you about. (Horton, June 21, 2004)
The explanations that I provided were not notable for their consistency or coherence. They
did constitute some direction in the interview, however, and likely influenced the responses
to questions about the meaning of capacity building.
Data Analysis
Data analysis was undertaken in a series of stages. These stages align with
classifications of data described by Sandelowski (2003), though the final stage was most
consistent with the interpretive description approach described by Thorne et al. (1997, 2004).
Sandelowski describes a typology of qualitative findings on a continuum, including no
finding, topical survey, thematic survey, conceptual/thematic description and interpretive
explanation. Though Sandelowski does not anticipate using the typology in an iterative way,

such a progression occurred during data analysis. These stages are described below.
Initially, a thematic survey approach incorporated all data within a framework drawn
mainly from Hawe et al. (1998, 2000) and included the categories of process, outcomes and

42

capacity building. Findings with respect to outcomes and capacity building were grouped
into those that affect the individuals involved, those that affect others and those that affect the
community. Consistent with the understanding of thematic surveys articulated by
Sandelowski & Barroso (2003), themes or concepts from existing literature were used to
label and organize the data.
A subsequent iteration of data analysis moved to differentiation of the data, within a
framework that moved closer to the research question by exploring the meaning and
experience of capacity building for participants. At this stage, the analysis remained strongly
linked to themes of existing research on capacity building experience, interpreting data in
relation to the activities described by Hawe et al. (2000), the actors and their purposes
decribed by Labonte & Laverack (2001) and the approaches articulated by Crisp et al.
(2000). Again corresponding with the typology of Sandelowski & Barroso (2003), this stage
was one of conceptual or thematic description, interpreting data in relation to concepts
developed by other researchers.
The final stage in data analysis was movement into interpretive explanation
(Sandelowski, 2003, p. 914) or what Thorne et al. (1997) call interpretive description.
Sandelwoski indicated in 2000 that qualitative descriptive studies are “less interpretive than
‘interpretive description’ in that they do not require researchers to move as far from or into
their data” (p. 335). However, Sandelowski et al.’s (2003) later explication of interpretive
explanation as “transformation of data to produce...fully integrated explanations of some
phenomenon, event or ease” (p. 914) is consistent with Thorne et al’s (1997) understanding
of interpretive description as an approach “grounded in an interpretive orientation that
acknowledges the constructed and contextual nature” of experience (p. 172). The final stage

43

of data analysis involved a process of moving more deeply into the data, consistent with
interpretive description described by Sandelowski (2000), and moving to interpretive
description by “asking ‘what is happening here?’” (Thorne et al., 2004, p. 14). The data
were re-examined to identify patterns and themes to make sense of the most important ideas
conveyed and to access their meaning in a new manner, consistent with the approach
described by Thorne et al. (2004). At this stage, for instance, critical examination led to
identifying the role of the health education workers as a finding of importance. Though
drawing from the method of qualitative description articulated by Sandelowski et al. (2000,
2003), the final stage of data analysis was most closely aligned with interpretive description
as described by Thorne et al. (1997, 2004). As Thorne et al. (2004) anticipate this analytic
process was a challenge.
Interview recordings were transcribed verbatim and transcriptions studied to identify
common themes. As described above, several iterations were required to identify the key
themes emerging from the data. Initially, all interview material was included in the
management of data. Gradually, the textual material was winnowed to include only the data
that spoke most clearly to differentiated themes.
The data included in the findings are those that speak to the meaning and experience
of capacity building for Yukon participants in this study. A sample of a data management
table is included as Appendix B. The data are discussed in the sections on study findings.
Rigour
Rigour has been assured in several ways. One was by ensuring the adequacy of data
by selecting participants by purposeful sampling from a number of different locations in the
Yukon. A second was by careful documentation of the evidence and a third by drawing on an

44

earlier study for purposes of comparison and verification (Morse, 1994). I also needed to
take steps to ensure that the perspective of participants was reflected in the findings. As a
long-time member of the Yukon community and a community health practitioner, I share
some experience, knowledge and assumptions with research participants. This perspective
has contributed to my ability to understand their experience, though there has also been
potential for this to hamper my objectivity, for instance, by limiting my conscious awareness
of assumptions behind the words used to describe experience. Several approaches have been
used to balance this embedded perspective and to ensure authenticity. First, I have engaged
in critical self-reflection to identify assumptions and/or other blind spots, using journal
keeping as an aid to the reflective process. A second approach has been to request all
participants to review interpretation of data with respect to their quotations. A third approach
has been iterative review of research findings and conclusions by thesis committee members
for the purpose of identifying assumptions and/or blind spots. Most frequently, changes have
been made to be explicit about, rather than assume knowledge of, the experience of Yukon
life. Rigour has thus been assured through study design and methods and by taking deliberate
steps to balance my embedded perspective.
Ethics
In addressing ethical questions, it was necessary to consider my own place within the
Yukon community. Politics was an element of this research in terms of personal and
positional relationships, and the corporate powers and policies of the Government of Yukon
(Punch, 1994). As an employee of the Department of Health and Social Services,
Government of Yukon, I am obliged to refrain from publicly criticizing policies on which I
may have influence from within government. As a member of the Whitehorse and Yukon

45

communities, I have established relationships and a need to maintain the integrity of both
present and future relationships. As a student exploring issues related to community health
with academic honesty, this presented a challenge. Having multiple roles imposes
constraints requiring particular attention to ethical issues that go beyond that which might be
required for a researcher with a less complex relationship with her community. Undertaking
research despite such constraints may contribute to moving towards critical assessment and
debate within the Yukon community.
Ethical issues were addressed by eareful research design, by addressing consent
issues, by assuring confidentiality of findings and by considering ongoing relationships with
participants. These issues are discussed below.
Research design
Care was taken to design a research project that would allow meaningful exploration
of a question of importance with a group of community health practitioners who are working
at arm’s length from my area of employment. It is acknowledged that the concern with
loyalty to workplace ethics reflects power relationships within the Yukon civil service and
could be seen as a limitation on academic independence. In undertaking analysis of findings
and drawing conclusions, academic freedom to advance knowledge was balanced with
accountability within the context in which the research was undertaken (Canadian Institutes
of Health Research, Natural Sciences and Engineering Research Council of Canada, Social
Sciences and Humanities Research Council of Canada, 2005). Although the subject of the
study is relevant to my work in the public service, and may be applied in that context, the
research was undertaken in such a way that it was clearly separate from work activity.

46

Analysis focuses on issues rather than specific organizations. Capacity building knowledge
has been gained while maintaining both academic integrity and respect for my employer.
Consent
Participant consent was gained at two stages, at the time of the initial interview and
on review of the quotations used, with the accompanying interpretation of findings. Written
consent was obtained from each participant at the time of the interview. Once findings had
been written, I sent their quotes and my interpretation of their words to each participant,
asking each person to let me know if they agreed to my use of their words with the
interpretation as written. All participants confirmed their consent to be quoted though, in
some cases, they requested amendment to the quotations to correet grammar or clarify
meaning. These amendments have been accepted, albeit with some reluctance on my part
because of the slight change in voice of participants. The amendments have changed words
from the way they were spoken to a more correct and formal construction. As a person who
rarely speaks coherently, I appreciate and accept the desire to make such changes, though I
regret the loss of the participant’s original words. In no cases were changes to the
interpretation requested, or required, as a result of the amendments. This process has
enabled the participants to be informed and to provide consent at two stages.
As unit employees were asked by their manager to participate rather than being
selected through random draw, a certain hesitancy to answer questions during the interview
raised my concern that individuals may have felt pressured to participate. A post-interview
discussion led me to believe that the hesitancy arose from confusion about what I was asking
rather than from pressure to partieipate. Any unacknowledged pressure to participate, was
balanced by the opportunity for each individual to withdraw consent at any time, should they

47

so choose, and by the second request for consent. If there was initial pressure to participate,
the pressure was ameliorated by the post-interview discussion and consent process.
Confidentiality
Anonymity could not be guaranteed to participants; however, confidentiality beyond
the interview groups has been assured. Neither participant nor community identities have
been revealed in reporting the findings in order to ensure that participant identities are not
revealed directly or indirectly. Although the assurance that individual and community
identity would be treated as confidential, not all participants wanted this assurance. One
participant noted her pride in the work she does and indicated that I could openly use her
name and community. The assurance of confidentiality was considered to be of importance
in order to facilitate participant ability to speak freely without concern that this would be seen
as disloyalty to the organization. In this respect, health education workers, when discussing
their work experience, could risk censure and, in light of this risk, the proposed precautions
with respect to consent and confidentiality in reporting findings were consistent with ethical
principles guiding research (Canadian Institutes of Health Research, Natural Sciences and
Engineering Research Council of Canada, Social Sciences and Humanities Research Council
of Canada, 2005).

In a population as small as the Yukon, revealing identity of participants

could inadvertently reveal the identities of people to whom participants referred. The latter
group would not have opportunity to provide consent to such disclosure. The limitation on
reporting on specific community details was required to respect the professional,
organizational and ethical constraints on the participants and on the researcher.

48

Ongoing relationships
An important ethical matter to be considered was the nature of my relationship with
the research participants. Although I did not know all of the participants prior to the
interviews, I did have established relationships with some through work or other interests.
Although these relationships may have contributed to my ability to gain access and
acceptance among participants (Punch, 1994), there was risk that the nature of my existing
relationships could constrain the rigour of analysis. I am not involved in direct supervisory
relationships with any of the participants, nor am I able to exercise independent power in
their interest or that of their program with respect to allocation of financial or other resources.
I am, however, able to exercise influence over allocation of resources that may benefit their
programs. A more subtle consideration is that of honouring mutual trust in present and future
relationships. This trust was respected by being very clear about the intent of the research
and the questions that were to be posed prior to obtaining participant consent and by offering
potential participants freedom to accept or decline the request to participate. Before and after
interviews, assurance was offered that information about programs and participants would be
held in confidence, as has been mentioned. Participants were also assured that research
analysis would be thoughtful, honest and considerate of the implications of their involvement
in the project (Canadian Institutes of Health Research, Natural Sciences and Engineering
Research Council of Canada, Social Sciences and Humanities Research Council of Canada,
2005; Punch, 1994). As mentioned previously, participants were provided with the
opportunity to comment on the analysis associated with quotations used from them as a way

49

of ensuring their eomfort with the interpretation given to their words. The ongoing
relationship that I may have with participants has been respected in several ways.
Ethical considerations have been addressed through attention to study design,
addressing consent issues, assurance of confidentiality of findings and attention to respect for
ongoing relationships with participants.
Conclusion
The methodology was designed to ensure that the research could contribute to the
body of knowledge about the meaning and experience of capacity building in general, and
particularly about that meaning and experience in the context of the Yukon. The participant
group was chosen because of their experience in capacity building work throughout the
Yukon in association with an organization to which the researcher was able to gain access
without being compromised by conflict of interest concerns. Data collection methods were
adapted to the circumstances presented by the situation. Rigour has been assured through the
design and systematic approaches to authentication of analysis. Ethical issues have been
addressed, with particular consideration of issues arising from undertaking research as a
member of a relatively small population center, where confidentiality issues, multiple roles
played by individuals in relation to the community and ongoing relationships are all relevant.
Implementing this methodology has generated new knowledge about capacity building,
reported in the following chapters.

50

CHAPTER FOUR
A bud opening in the sunshine: The meaning of capacity building

Introduction
The intent of the research has been to learn about the meaning and experience of
capacity building by health education workers in the Yukon. Workers were asked to describe
the process of undertaking an activity, what helps and hinders that process, what they saw as
the outcomes of their work and whether and how they saw capacity building as being part of
their work. In responding, participants spoke of their successes, their challenges and the joys
they have found in their work. It is my regret that all of the wisdom they imparted cannot be
recorded here. In all interviews, participants asked for an explanation of what I meant by
capacity building. With a brief explanation of capacity building, for instance, as “one of the
things that happens as part of a health education or health promotion activity. ..with indirect
effects that are beyond the activity themselves and that have the potential to influence
determinants of health”, participants responded with interest and insight to the questions
about it, based on their thoughts, observations and experience. Meaning is understood as the
significance ascribed to activity, while experience is understood as knowledge arising from
observation or practical acquaintance (Canadian Oxford Dictionary, 1998). Findings about
the meaning of capacity building are discussed in this chapter, followed by chapters on
participant experience and observations in the Yukon context.

Role o f the organization
The role of the Yukon College Public Health and Safety (YCPHS) organization was
not explored directly in questions to participants, but emerged in the course of interviews. As

51

the organizational role is germane to the findings, a brief discussion of that role is useful to
set the findings in context. Prior to undertaking the interview, the employee members of this
group identified themselves as taking a capacity building approach to their work. Staff from
the YCPHS organization were among the participants interviewed for the study; their roles
encompass both organizational and instructional work making it difficult to distinguish
between the organizational and front-line roles, and impossible to do so while respecting the
confidentiality of participants. The organizational role was identified as one of facilitation
and support for the activities of the health education workers.
An example of how the organization facilitates capacity building is in the
development of the network of instmctors, as described by one participant:
(In) 1996 or 1998, the College said, “Why won’t you teach first aid?” And I said,
“Well, I can’t because you have to be an instructor.” “So, we’ll pay for you to be an
instructor.” So, the College asked me to be an instructor so that’s when I started
actually teaching for Yukon College Public Health and Safety. (5A)
The organization is actively involved in recruiting people to become instructors and in
providing support for them to do so. In doing this facilitation work, the organization aets as a
catalyst to enable the instructors to apply their skills in instruction in their communities.
The organization also supports the health education workers in undertaking their
activity. Many participants described how such organizational support was seen as helpful to
them. One participant described the many aspects of organizational support in these words:
It’s definitely easy to do.... They’re very well organized in the office. They have
everything set up. They’re very accommodating for people, when people call on the
spur o f the moment. They try and find instructors. They always have the equipment

ready for you. They have all the forms in place. I guess one of the things that they
just did recently that was a big help is they did like a, what they called a Red Cross
symposium, which was sort of like a professional development type day, and that was
very helpful. It was a little bit inspiring because it got you together with people and
... brought some speakers in with some current sort of information and things, and

52

that type of thing I think is very valuable because sometimes you can feel very
isolated teaching. (4A)
The support includes the organization and provision of resources such as instructors,
equipment and administrative management. It also includes professional development
opportunities that enable both ongoing learning and the opportunity to be together with other
people with similar interests and experience.
One theme to be explored in the research study was the facilitators, dilemmas, and
issues for workers in capacity building. When the order of questions was changed to move
from describing the process to reflections of capacity building, the questions related to this
theme were changed, such that participants were asked what helped and hindered them in
their work, rather than what helped or hindered capacity building. W ith the questions
worded in relation to their work, the responses were not specific to the experience of capacity
building and, as such, have not been explicitly reported in the study findings.
The study focuses on capacity building from the perspective of health education
workers, but the organizational context within which this group works is part of the complete
picture of the capacity building work. It is in order to paint the full picture that the
organizational role has been discussed preparatory to presentation of other findings.
Meaning o f Capacity Building
The meaning of capacity building was sometimes expressed in conceptual terms and
sometimes expressed as reflections by participants on the significance of their activity. The
themes that em erged were that capacity building meant building on strengths, building on

opportunities, empowerment, and relationships beyond the individual. The themes, often
intertwined with each other, are described in this section.

53

Building on strength
For participants, building on strengths means helping people to develop their existing
abilities and potential to achieve new knowledge and skills. Participants indicated that there
is potential for everyone to build capacity in their own lives and that this occurred through
building on the strengths within that person. For participants, building on strengths means
that there must be belief that strengths exist, as abilities and potential for achievement, and
that there must be recognition of the strengths and a response to their existence. These
elements of belief, recognition and response are discussed here.
Building on strengths starts from the belief that strengths exist. Although many
participants implied this belief, the belief was made explicit in the statement below:
I think there’s almost an unwritten philosophy in the department and from how I see it
is, number one is respect for every individual and every individual’s ability to build
their own capacity, and in doing so, to increase the capacity built around them, be it
Faro, you know, in their own community or all the way up to the national and when
we talk about Red Cross, I say that’s an example of international contacts and ability
to influence. (IE)
The participant clearly expresses her foundational belief that every individual has ability to
build their own capacity and that of the people around them. The participant also identifies
the interrelationships linking individual to collective capaeity that can reach beyond the
individual as far as influence on international activity. A basic element of building on
strengths is the belief that there are strengths in every individual on which to build.
In order to act on the b elief that every individual has strengths on which to build,

there must be recognition of strengths when they exist. Thus, part of the meaning of building
on strengths requires understanding the strengths that people have. One participant

54

illustrated this understanding when she identified the strength of self-reliance among the
people with whom she works:
And they’re very reliant people on themselves. They like to take care of themselves,
so you give them the knowledge, and it’s there. (5A, amended)
Without the understanding on the part of the participant, there would be no recognition of the
strengths that exist, and therefore, no ability to respond to the strengths. The participant links
learning with empowerment, seeing that knowledge enables people to increase their selfreliance. Recognizing strengths is essential to being able to build on those strengths.
In addition to believing in and recognizing strengths, building on strengths means
being able to respond to the strengths that exist. One participant identified the existing
knowledge of people she worked with as a strength on which she builds in working with
them. In this case, the knowledge of anatomy and physiology that comes from the
experience of hunting is transferred into the experience of learning first aid.
... when we go over anatomy and physiology, I try to make it relevant to what the
students had experienced. Most of the participating students have been hunting so
they know from cutting the moose where the heart is; they know where the lungs are.
This makes them relate to what is being taught and that makes them feel good
because they know something.
And this is the teaching method that we like to apply by incorporating the
practical skill and knowledge of the participants. Just because the student may have
difficulty in reading or difficulty with math, he or she may have other knowledge that
I’m sure he or she is pretty good at, so let’s just work on those strengths and steer in
that direction. (2A, amended)
Embedded in this statement is the participant’s understanding that the people with whom she
works may not always have experienced success in learning, for instance, in reading or math.
So also, is the participants’ understanding of the kind of knowledge that the students do have
that comes from her awareness of the lives and lifestyles of the people in that community. In
describing her approach to teaching, the participant indicates her belief that her students have

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strengths, her recognition of the strengths that they have and her response of teaching in a
way that can help the students learn from those strengths. The participant builds on
opportunity as well as on strength by building on success in one area of an individual’s life to
achieve success in another. The meaning of building on strengths is put into practice by
responding to the strength of knowledge from one area, hunting, to build knowledge in
another area, first aid.
In speaking about the meaning of capacity building, participants identified building
on strengths as one theme, linked with the themes of building on opportunities,
empowerment and interrelationships. Building on strengths means that there is respect for
individuals and the strengths they bring to a situation, that there is awareness of the strengths
that exist to build upon and that there is a response to support the existing strengths.
Participants are aware of the strengths and able to recognize them because of their
understanding of the people with whom they work. Responding to the strengths means
assisting students to apply the knowledge and abilities that they have in one area of life to
learning in a different area. The elements of belief, recognition and response are elements of
the theme of building on strengths within the meaning of capacity building.
Building on opportunity
Participants indicated that building on opportunities meant responding to chances to
achieve a goal when such possibilities arise. Participants indicated that building on
opportunities is part of the meaning of capacity building. Implicit within the idea of building
on opportunities is the intent of doing so to a particular end, that is, an opportunity is used to
achieve a vision for improvement in some aspect of community life. Building on
opportunities may mean expanding the range of groups to whom participants offer a learning

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or development experience in a community, or using success in one area to achieve success
in another, at both individual and community levels. These elements of building on
opportunity are not exclusive of each other. The words of the participants indicate how they
understand building on opportunities as part of the meaning of capacity building.
Participants indicated that building on opportunity could mean expanding the range of
groups to whom a learning or development experience is offered in the community. Several
participants told of identifying and acting on opportunities that present themselves. In the
example below, the participant originally taught first aid only to people providing volunteer
emergency services in the community. This led to other opportunities:
And then if there is an interest shown by people in the community. I’ll teach courses.
So I started including or making them open to people in the community because it’s
obviously a community oriented organization and we’ve got more people taking it
who are not active volunteers (in emergency services) who take it because they want
to learn. And then I had a request last year to teach some courses for ehild/infant first
aid and CPR. We had all of a sudden a whole bunch of kids arrive out here and
eoneerned parents who know w e’ll get there when they call us (i.e. ambulance) but to
be able to take care of their kids at home before we get there or do things that they
don’t have to call the ambulance for. (8A)
The participant identified and acted on interest that was expressed in the community by
making first aid classes available to a wider group of community members than he had taught
initially. In taking advantage of the opportunity to expand the range of people in the
community to whom first aid instruction was made available, the participant helped
individuals become more able to cope on their own in emergencies, thus becoming
empowered through greater self-reliance. This example illustrates that building on
opportunity to achieve an end is part of the meaning of capacity building.
Participants indicated that an aspect of building on opportunities means building on
previous success. One example given above described building on one area of knowledge

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(hunting) to apply in another area (first aid). Building on previous success may also mean
expanding from one to several locations, as described below:
I work with Yukon Food for Learning, which supports nutrition programs for all the
schools in the Yukon. ... It started off with just Whitehorse Elementary School and
now we have a program in almost all of the Yukon schools, just two more to go. (ID )
This example illustrates that programs do not need to be established on a universal basis
available to an entire population in the beginning. By expanding the Food for Learning
program, better nutrition has steadily become accessible to more school children.
Participants indicated that success in one area helps to achieve success in another, illustrating
the meaning of building on opportunity as an element of capacity building.
Building on opportunities is predicated on having knowledge of what and where
opportunities might exist and on seeing possibilities for achieving a desired end. One
participant built on the opportunity to expand first aid programming to empower people to
become more self-reliant and one person steadily expanded the scope of a school nutrition
program. Building on opportunities may start with a participant offering a program to a new
group or expanding to new locations based on success in one place. For participants,
building on opportunities means that they are sufficiently aware of themselves and their
communities to be able to identify when there is potential to take action that could lead to an
end that matters to them and to take that action.
Empowerment
To empower is defined by the Canadian Oxford Dictionary (1998) as to “provide
with the means or opportunity necessary for independence and self-assertion”, to “make
able” or “to give power to” (p.458). Empowerment is defined as “the means by which people
experience more control over decisions that influence their health and lives” (Laverack &

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Labonte, 2000, p. 255). Empowerment can occur at individual, organizational and
community levels, with individual empowerment being “people’s self-efficacy and control in
their lives” (Wallerstein, 2006, p. 18). Participants expressed ideas about individual
empowerment in terms that indicated understanding it as a bottom-up process of enabling
others rather than a top-down one of giving power, an understanding that aligns most closely
with the Laverack and Labonte definition of the term. For instance, participants described
empowerment as providing the means for people to achieve independence or self-sufficiency.
Several participants spoke of the work of enabling people to become more self-reliant or
more able in their own lives, speaking of empowerment without giving it that name. In one
discussion, empowerment was the word used by participants to give meaning to the values of
reduced reliance on resources from outside the Yukon and of gaining knowledge or skills for
personal change. As one person described her experience, another person in the group gave
that experience the name ‘empowerment’ and identified what made it that.
So I just had a thought I just wanted to comment on because, thinking about the
Advanced course that I teach, that it used to be that the students that take that course
used to have to access that course outside the Yukon or we had to bring instructors up
from outside the Yukon, so what I have heard since we’ve been teaching that course
here is that certainly there are students now that come back to take it or look forward
to taking it in the Yukon with local instructors who can understand how things are in
the Yukon, or how things are in rural Yukon, what resources you have to respond to
things, and I think that’s a positive thing, too, that they’re here rather than going off to
the large city centre where they have, you know, there you call the cardiologist, you
call the neurologist, and we don’t have that so we have to build our course to how you
would deal with things with what we have here right now and I think that’s been a
good thing. And I would agree with (another participant) in that, yeah, it’s often with
my students, too, we talk about risk factors because certainly we see people at risk
every day but you often forget about your ow n health and what w e ean do to improve

our health as well. So I think that certainly becomes aware in the course. (9A)
Both of those things are really empowering, too. At the local level to realize th a t...
(a) you don’t have to depend on outside resources or, (b) that you can change your
life if you do things. There’s a real empowerment focus that can happen in both those
factors. (9B)

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Empowerment was articulated by this participant as enabling reduced dependency on
resources outside the Yukon and providing the means to improve personal health. Reducing
dependency on resources from outside the Yukon means that there is increase in self-reliance
within the Yukon and, at the same time, an increase in the relevance of the teaching because
it is based on ‘how things are in the Yukon’. Increasing the knowledge of what can be done
to improve personal health means that people have greater opportunity to be independent in
self-care. Empowerment as providing the means for people to become more able to be
independent was given specific meaning in the areas of self-reliance and self-care.
The concept of empowerment as an element of capacity building was sometimes
described without being named. The idea of people expanding, expressed below, is
consistent with the meaning of empowerment as enabling or giving power to people.
when I think of capacity building... I think of people sort of expanding... To me,
capacity is about skills and knowledge and how you use those things in the
community and hopefully when somebody goes through a first aid course, it’s not just
what to do in an emergency but it’s a whole, everything that goes along with that.
(4A)
In speaking of people expanding, the participant indicated her understanding of
empowerment as including new skills and knowledge, but extending beyond the specific
skills and knowledge to ‘everything that goes along with that’. The concept of empowerment,
whether or not it was named as such, was identified as an element of capacity building. For
the participants, empowerment meant enabling people to achieve greater independence in
self-reliance or self-care and in helping people expand beyond the specific skills being

taught.

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Having effect beyond the individual
The idea of empowerment as people expanding within themselves and in relation to
their eommunity provides a natural transition to the idea that capacity building means starting
with an individual but having effect beyond that individual. For participants, relationships
beyond the individual mean that the increased knowledge, skills, and abilities achieved by an
individual have effect beyond the individual. Participants observed that the effect of their
work extends beyond individuals to their influence on families and communities and beyond
specific knowledge and skills to influence on other sectors of the community. Sometimes
the extent of the interrelationships cannot be known. One person spoke of the
interrelationships metaphorically when she compared the individual to a closed bud:
And I think that one thing leads on to another, so the bud gradually opens up to more
sunshine, with the result that he or she feels better about himself or herself, and that
hopefully gets passed on towards the family and benefiting the family members as
well. (2A, amended)
The relationships beyond the individual are tied to the learning that an individual has
acquired but extend beyond the individual in their influence on family and community.
Some participants noted building in one part of community life contributes to
increased capaeity in other areas. One participant described the intertwined nature of effects
of different sectors within a community.
And that’s the whole thing though about capacity is that it’s really hard to take it out
and put it into one discipline because there’s so many things that are intertwined and
interlaced .... I think that everything sort of ties in and, for example, like in (a Yukon
eommunity) for example, if the community can build, like the health affects the
economy which affects the social structure which affects the ability to go to school
and learn things and everything, like you can’t take one thing out and look at it on its
own because one thing affects all the other things that are there.. .It ties together.
(4A)

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Relationships beyond the individual include influence in different sectors or disciplines of
community life in a way that ‘ties together’, including health, economy and social structure.
Some participants indicated that the interrelationships of capacity building are not
necessarily something that they are able to know. One participant described this as a ripple
effect, starting with specific skills but going beyond those skills:
I think any kind of learning has a ripple effect. It’s obviously indirect. You’re
probably not going to notice it in many cases. But everybody is so interlinked and
inter-related in so many ways that we don’t even know about, it’s got to. Again, I
teach first aid so people know what to do, it’s perhaps not only you’re helping the
people when they have to deal with a first aid situation but you might be helping
someone who’s travelling with that person. I mean everything is interrelated, my
goodness. Not just even the specific skills but everything around it. (lOA)
For this participant, the expansion of influence beyond the individual is not just about
applying a skill, but about increasing knowledge and ability that has an effect on others in
ways that cannot be known.
Although tied to learning specific skills, participants noticed that part of the
meaning of capacity building is the interrelationship between the skills gained by an
individual and the effects beyond that individual. Building individual capacity ripples out to
building community capacity such that the individual and community cannot be separated
from each other. Effects ripple from the individual to the family and community, from one
discipline or area of community life to another and to areas of life that are interlinked and
intertwined within and beyond the knowledge of participants.
Conclusion
The meaning of capacity building articulated in this section is grounded in the
Yukon experience and the understanding that the participants have of that experience. Based
on their words, capacity building has meaning with respect to building on strengths and

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opportunities in the Yukon context, to empowerment, and to relationships beyond an
individual. Building capacity is predicated on the participants’ ability to recognize and act on
strengths and opportunities to build their own capacity and that of the people in the
communities around them. Empowerment can mean enabling people to increase
independence, for instance, by reducing their reliance on outside resources or by gaining the
tools for better self-care. The concept of empowerment was illustrated in experience such as
expanding to school nutrition programs, making learning opportunities accessible to fellow
ambulance service members, or enabling parents to be more skilled and confident in caring
for their children. In articulating the meaning of capacity building, participants consistently
spoke of individual learning that had effect beyond that individual in the communities of
which they are part. This is an important insight into the link between the ideas of individual
capacity building and community capacity building. Yukon participants indicate that the link
is made through the work of individuals who have gained knowledge and skills by building
on strengths and opportunities, have been empowered through that experience and through
that empowerment have the potential to have impact on the broader community.
Most participants did not have an established idea of the meaning of capacity
building at the outset of the interviews. However, after a brief explanation of the concept,
participants described their thoughts and practice in ways such that the meaning of capacity
building became clear. Thus, one conclusion that became apparent was that a conceptual
understanding of capacity building was not required as a precursor to capacity building
practice. Capacity building practice in the Yukon context is described in the following
chapter.

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The meaning of capacity building is multi-faceted, in the experience of participants.
It stems from a belief that every one has capacity to build, and is fuelled by a vision that
some aspect of life can be improved for individuals and for communities. Capacity building
means building on strengths and building on opportunities, it means empowering people to
expand in their lives and it means impacts that include effects on individuals but go beyond
individual to influence families and communities, in ways that are sometimes known and
sometimes far beyond what we ean know. Capacity building means a bud opening in the
sunshine.

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CHAPTER FIVE
Working together: Process and role of health education worker

The understanding of capacity building developed for most participants from their
experience of teaching first aid classes. Their understanding evolved from the observations
and practical acquaintance with capacity building that they made in the course of that
experience. Four main themes emerged in the experience described by participants. One
was the process involved in undertaking an activity. A second was the role of the health
education worker, a role that is at the heart of the experience of capacity building.

A third

theme was the relevance of the Yukon context in the experience. The final theme was the
effect or outcomes of the teaching, including but going beyond the skills taught. The themes
about process and role of the health education worker are discussed in this chapter, followed
by discussion of contextual factors and effects of capacity building in Chapter Six.
Process
Participants were asked to respond to a question about the process or steps that they
go through in undertaking an activity. The steps identified in the process included initiating
activity, organizing program delivery and teaching the courses. The teaching process
included advance preparation and adjusting to the needs of the group. Some participants
were involved only in teaching, while others were involved in all steps of the process.
Participant responses to the questions about process are provided in this section.

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Initiating activity
A part of the process in undertaking an activity is initiating it. One story told by a
participant who became a first aid instructor illustrates the complexity involved in initiating
an activity. The community did not have ambulance service at the time that her story started.
So, her and I talked and I said, “Why don’t we do a first aid program?”
Well, she looked at me and said, “Well, it’s been done before.”
“Oh.” I didn’t know the history so then I started talking to a couple of people and
they said “Yes, it’s been done but they (the instructors) won’t come out here
anymore”
I said, “What do you mean they won’t come out here?”
“Well, people won’t show up.”
So I called them (i.e. Yukon College) and I said, “W hat’s the problem?”
And they said “Well, they’ve come out about five times, nobody has shown up for the
class or one person has shown up late... so w e’re just not going to put the money into
it” ...
So (the other community person) and I sat down and said “Well, why aren’t people
showing up?” So we had a good conversation about what she thought the issues
were. She said, “Well, it’s early in the morning”. It was in the wintertime, right.
People ... at that time had very little running water, had wood stoves, so by the time
you got your kids up, breakfast made, it’s ten o ’clock. You’re supposed to be at a
course at 8:30 in the morning because the instructors come out and they have their set
hours and they have to get you into that little notch. And so, then she said, “the other
thing is, then if they rush, they haven’t eaten, so they’re tired and they’re hungry.”
So I made breakfast and she went and got everybody out and the instructor came and
did the course. We had 14 people.. .And 14 people passed and we got our ambulance
crew and our ambulance, right like that.
This was the first community development project that I was active in and was
successful - it taught me a lot. We worked together and achieved what we wanted to.
.. .We had to get that ambulance crew going because they wouldn’t give us an
ambulance. (5A, amended)
The story provides a rich illustration of the process of initiating activity within a community.
An idea, what some would call a vision, to have a first aid program in the community was
identified and discussed with another person in the comm unity. H owever, a problem in

implementing that idea was identified, based on previous experience. Together the two
people identified a possible solution to the problem. They talked with people and learned
more about the previous experience in that community. They tried to figure out the factors

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that had prevented the activity from being successful in the past and found ways to address
those factors. They accomplished something for and with the community that enhanced
community self-sufficiency by getting an ambulance service started. The story illustrates
how complex it is to initiate activity in a community, the teamwork required, the value of
inside knowledge of the community, as well as the need for outside resources and the ability
to mobilize those on behalf of the community. The story also illustrates the very tangible
benefit that can be gained from such activity. Within this story, there is a vision that things
could be improved and a description of the process involved in bringing that vision to reality.
The story is an examplar, not just of the complexity of work involved in initiating an activity,
but also of the role played by the participant in doing so.
Organizing program delivery
Network members identified steps in undertaking an activity that were specific to
organizing program delivery. These steps included planning and scheduling the courses to be
offered, communicating about and preparing for the activity, as described below:
In the old days, we used to advertise the courses and say that once the course was full,
we would proceed with it, but we found that this method was not really very efficient,
so we pre-set a timetable for the courses when they were going to happen. As a result
come September I would have a list made up right until June of when and what
courses are going to be, what the cost is, what is the maximum/minimum number of
students in it and how long the course is going to be. This gets posted around the
community, plus it gets faxed to every organization we can possibly think of in (the
community). We also advertise this to (a nearby community)... and the schools, the
teachers. Also word-of-mouth is very effective because people don’t look at
posters.... we have a sheet where people come and register and we just add the names
to the list and ... We then get an instructor organized, let him or her know that the
course is happening, and w e get everything ready for the instruetor. A ll the supplies

and training materials are in the College, so we don’t have to bring anything in, and
we are ready to proceed with the course. (2A amended)
And the other thing in the small communities, they’re very spontaneous about when
they need things. ...So if something comes up in November that this group is being
started, but they all have to have first aid, well they can call on the local instructor,

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where if they have to bring somebody up from Whitehorse, whose time is booked for
the next three months, you can’t adapt. (5A)
The participants indicated that program delivery was modified over time in response to
lessons learned about what is effeetive. The specific logistics may vary for different groups,
but the steps are essentially the same; planning for delivery of programs occurs according to
the needs of the community, communication with key persons occurs and the spaee,
instruction and equipment is organized for program delivery. Knowledge of the community
is revealed in these accounts, including the knowledge of what will effeetively enable
program delivery in a community. Planning for program delivery requires awareness of and
ability to mobilize the resources in the way required to achieve success in that community.
Teaching
Teaching was identified as part of the process of undertaking an activity.
Standardization of the Red Cross curriculum limits ability to modify first aid course content,
but there is enough flexibility that participants put their own stamp on program delivery.
Participants described the teaching process in terms of advance preparation and of adjusting
to the needs that arise when instruction is in progress. These findings are presented here.
A number of participants spoke of their advance preparations for teaching, including
preparing for their audience, augmenting their teaching resources and adjusting class size. In
the examples below, participants describe how they make these advance preparations:
And the first thing that I need to know is who am I instructing ... if you’re dealing
with a group of teenagers, or if you’re dealing with Parks Canada who’s back for their
recertification every single year, you ’ve got to really approach it with a little bit o f a
different manner. So you need to know who your audience is. (6A)
... it’s our job to have our teaching resources together ... that’s something that I think
we all build over time and add to and it evolves. (3D)

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And also the nice thing is that I can keep the class size small here because I’ll just do
it several times and include everybody by the time it’s over. And so you don’t have
these big classes where people get bored and fall asleep. (8A)
Advance preparation for teaching is not unique to first aid instruction; it does, however,
facilitate the interaction between the participant, working as a health educator, and other
members of the community. The interaction in the teaching setting is personal; participants
indicate that this is apparent to them in planning for the size of the group, anticipating the
prior knowledge and interests of the group and preparing relevant course materials. Advance
preparation is an aspect of the teaching involved in undertaking an activity.
A number of participants indicated that their teaching approach varies according to
the needs of the group being taught. In these instances, the instructors respond to the
circumstances that emerge while they are teaching. Adaptation to the needs of a group being
taught often requires an immediacy of response to a situation that arises in the class setting:
There’s a lot of extra time put in, because of. I’d say, literacy issues within the
community and within the people in the group. Or fright issues. People get nervous
about performing in front of other people so if I think that they can do it, I just say,
“Well, why don’t you and I do it later after the class. You just stay later and I’ll go
through it with you”, something like that. Because there are people that just can’t
“perform” in front of others when they are learning things for the first time - 1 am one
of them. (5A, amended)
And of course every group’s different so the way you might explain one thing might
be completely different with one group as compared to another. Or the gender
makeup of the group, for example, with some groups where it’s primarily women, we
have a lot more discussion about women and heart disease, because of more recent
findings and things like that. If there’s more people who are parents, we might talk
about more things pertinent to children.... I have my lesson plans. I have my
teaching aids, my activities, everything all laid out. But I try and read the group, so
that if something that’s o f interest com es up that you can divert and sidetrack for
awhile and then still come back and make sure that you cover the core material.” (4A)
Sometimes it’s the buddy system. You take somebody with more experience and put
them with somebody with less experience. Because our program takes more days,
more hours, to deliver, we have an opportunity of taking somebody w ho’s got
absolutely no experience and we can buddy them up with ten people over the period

69

of the time that they’ve got there. So they end up being able almost osmotically to be
able to kind of pull in the knowledge that these other people have got. (6B)
The examples above indicate that participants modify their teaching approach according to
learning needs of participants, according to the interests of the group, and according to
learning styles, often with recognition of the strengths that people bring to a particular way of
learning. The examples illustrate that there is value seen in teaching in ways that involve
hearing, seeing and doing in order to facilitate learning in different ways. As in advance
preparation, responding to the needs that arise in the teaching setting involves personal
interaction, but in a way that must be accommodated as a need arises. The examples indicate
that the participants are attuned to the needs that arise in the instructional setting and are
adept at making adjustments to meet these needs using the resources available. Participants
enable achievement for the people they are teaching, in part because of understanding and
adapting to the needs that those people present during the instructional experience. Adjusting
to the needs of the group is part of the teaching process.
Participants described their activity as including initiating activity, organizing
program delivery and teaching courses. In some cases, initiation and organization was done
by others within the organization, with participants involved only in the teaching; in other
cases, participants are involved multiple aspects of the process. In their teaching activity,
participants described their advance preparations and their adjustment to the needs of the
group according to the issues that arise while a course is in progress, taking advantage of the
interest, know ledge and strengths o f the people being taught. The aetivity in which

participants are engaged includes multiple aspects of program initiation and delivery.

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Role o f health education workers
In describing the process of capacity building in the Yukon, participants identified the
pivotal role played by the health education workers. This was not something to which the
participants drew attention; they were not seeking or claiming credit for things that had been
accomplished. However, it was apparent from the stories that were told that the role played
by them was an essential element in the things that were accomplished. Six areas were
identified in which the health education work role is played. These areas are initiating
activity, building their own capacity, enabling achievement, understanding the meaning of
experiences for those with whom they work, building relationships and a final area that I
have called living in relationship with community. These six aspects of the health education
worker role are discussed in this section.
Prior to undertaking this discussion, it is important to clarify that the roles played by
participants occur within a context of organizational support, described in Chapter 4.
Embedded in the experience of capacity building for the participants is the opportunity that is
provided to them to develop skills, pursue interests, gain confidence in their abilities and to
receive support in providing service in their communities. Staff from the YCPHS
organization were among the participants interviewed for the study; their roles encompass
both organizational and instructional work making it difficult to distinguish between the
organizational and front-line roles, and impossible to do so while respecting the
confidentiality of participants. Although the differentiated roles of the organization and
health education workers have not been pursued in this study, opportunities and support are
provided to the health education workers by the Yukon College Public Health and Safety
(YCPHS) organization.

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Initiating activity
The participants, in their role as health education workers, frequently initiate activity
in their community. One participant made this observation:
The instructors are not always waiting for us to offer them programs. They come and
they want to be doing things, different things, like they know they will receive
support. Like they’re not, you know, sometimes people will sit and wait. OK, what’s
going to happen next? But they will come forward and they have these ideas that
they would like to start themselves and receive the support for it. (1C)
It was clear to this participant that many of the health education workers are involved in
initiating activity. As discussed in the process section, initiating an activity can be a
complex process that involves many components. The story of initiating a first aid program
in a community in order to obtain community ambulance service illustrated this complexity.
In initiating the activity, the participant started with an idea that something in her community
could be improved, built relationships within and beyond her community, learned from
previous experience and secured the necessary resources to undertake the activity. She
developed an understanding of community circumstances and learned how to work with
those to enable achievement and to empower community to achieve greater self-sufficiency.
Through her work, she created opportunity that did not previously exist in the community.
In other situations, initiating an activity may be more straightforward, as described by
this participant:
I am a long-term ambulance attendant on the (community) ambulance.... And when
it came to recertifying our first aid or CPR, it was always quite a hassle to get
someone up to teach us. So, an opportunity presented itself (to become an instructor)
and I grabbed it. ... it’s m ostly for in-house, our own ambulance crew

I’ve also

done it for the RCMP and I’ve done it for the highways crew this spring. Teaching
first aid courses here in (the community), just to make it a little easier. But mostly for
emergency services. (lOA)

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This participant had a goal to improve life in her community, that is, to provide better access
to first aid instruction for the emergeney services providers. She recognized that she could
do something to achieve that goal, took advantage of an opportunity to gain instruction skills
and put her new skill to use in providing instruction in her community. The participant took
advantage of an opportunity to build her own eapacity, the means by which she was able to
bring her idea to fruition. In both examples, participants identified a vision or end that they
hoped to achieve and a process for achieving that end. In both cases, the end achieved was in
the interests of the larger community. In initiating activity, the partieipants enabled capaeity
building in the community through their own actions.
Building own capacity
As mentioned above, participants may take opportunities to build their own capaeity
as a step to providing an opportunity to build capacity in their communities. Many
participants spoke of their own development in becoming a first aid instructor. Consistently,
their intent was to use their own inereased capacity to build capacity in their community.
The following story illustrates this pattern:
I originally joined because we need ongoing training here ... and it was very difficult
time-wise for people to go to town to get the training. When I joined four years ago
we just did not have adequate training. No one was up to date in first aid, CPR. And
I was approached by someone. I can’t remember who approached me, and (I) took
the course three years ago at the College to become a certified instructor. (8A)
In the example given, the need for community first aid instruction was seen, a way of
addressing the need was identified to the participant, and the participant responded by
becoming qualified to provide instruction. Although this story is told to illustrate how
partieipants take advantage of opportunity to build their individual capaeity as a step to
building community capacity, it also shows the elements of initiating an activity that were

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discussed above. The lived experience of initiating activity and building their own capacity
is integrated for participants, one activity does not necessarily stand in isolation from other
activities. Development of skill and ability is based on an individual’s own interest and on
the opportunities that enable them to progress in pursuing their interests. The words of
participants reflect an interest in and commitment to community interests evidenced by their
decisions to accept opportunities to build their own capacity in the interests of better serving
those broader interests.
Enabling achievement
The participants have a role in enabling achievement in their community. It was
explained earlier that the meaning of capacity building includes building on strengths and
building on opportunities. The health education workers are the people who recognize
strengths and opportunities, who do the work of building on them and who enable
achievement in doing so. For participants, enabling achievement can include making
learning opportunities accessible and overcoming their own biases. One participant
described the enabling aspect of the capacity-building role in broad terms:
I do see it as part of our work, just by nature of the training that goes on in
Whitehorse or any of the communities. ... our programs are enabling for people to do
little steps or great steps towards employment or just completing something. Not
necessarily, you know, a university degree or something, but for some people, that
can be a real sign of achievement, and also for those who are highly educated, it takes
them down a different pathway as well. (lA )

The participant makes the point that the work of enabling achievement includes making
opportunities available for all people who are interested in being involved in the programs.
Achievement can be enabled regardless of where a person may be starting from in terms of
their previous level of education or other achievements.

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Several participants spoke of dealing with literacy issues in enabling achievement.
They indicated that it is the attitude brought by the instructor not the level of literacy that
affects the ability to achieve. One participant put it this way:
I think my biggest issue with capaeity building is literacy. You can’t build it unless
the people understand what you’re talking about. And like I said, I’ve done a little bit
of research. It’s not very much, but my understanding that the literacy level is lower
than we expected and we need to accept that rather than challenge it
people
watch very carefully in these courses, and they very much learn from watching, so if I
do a dressing a certain way, then they will learn it. But if I tell them how to do that
dressing a certain way, they can’t learn it, because the words are difficult. When
words are too hard for someone to understand, they spend a lot of energy just on
understanding the words and miss the lesson being taught. Or they stop listening as it
is just too tiring. Let’s use both the common words and the showing to teach them.
(5A, amended)
Literacy is an area where the approach taken can enable achievement. Starting from where
people are, rather than where somebody else thinks they should be reflects a philosophical
orientation of respect for each person. It means believing in every person having capacity to
learn if they have the opportunity to do so in a way that is accessible to them. It is the health
education workers who make learning opportunities accessible through their understanding
of the people with whom they work; in doing so, they enable achievement.
Enabling achievement is not always easy for instructors. It can mean having to
stretch pre-conceived notions on their part to make opportunities accessible to people who
might otherwise have been excluded from participation. This participant laughed at himself
as he described his own evolution in one situation:
One little story you might enjoy is - it was a year ago. I’d advertised a course. I got a
call from this girl who knew me and she wondered what the age cutoff was for the
class. She was only 16. I thought, oh je e z ... .1 knew that a couple of the people in the
course were in their fifties. The rest were in their thirties and forties. Oh boy. So I
called the college and talked to (one of the staff) and she said there is no cutoff age, as
long as they’re physically able to do the CPR, but it’s up to you. I didn’t really want
to. Also, the conversation, you know, when you’ve got somebody that age, as
opposed to adults, the conversation is different and it’s such a big jump. So anyways.

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I said okay, w e’ll do it. I said, “You’re going to have to pay out of your own pocket’’
because, of course, you figure our volunteers for the ambulance are paid for by the
government but “you’ll have to pay out of your own pocket, 135 bucks’’, but she’d
been saving. That’s a lot of money for a kid. And I gave her the books. She
memorized the books, basically, before the class. And she was essentially the star
pupil. She got the highest score on the written test, did just, it was amazing. ... she’s
going into health care at some point when she grows up - she’s already very mature.
It was just amazing. She wrote me a thank you card afterwards because she knew I
had some trepidation about it. And she thanked me for giving her a chance. It was
neat. I run into her and her family every now and then, I saw them at Canada Day
and she’s still so happy about it. She’ll tell me about things she’s done, with her
sisters. They live out in the country and there’s always first aid stuff. She hasn’t
done any life saving, but she will. (8A)
The participant enabled achievement for this young woman because of being able to work
through his own concerns about the appropriateness of providing an opportunity for her. He
recognized the strengths of interest and commitment that the young woman brought to the
situation and overcame his own trepidation to make an opportunity available to her. In these
stories, there is evidence of the participant’s understanding of the needs and desires of people
in their community and a willingness to meet challenges as necessary in order to work with
the people to provide an opportunity to meet those needs and desires. The attitude and
approach of health promotion workers is a critical factor in enabling achievement.
Understanding meaning
Participants told stories that indicated their recognition of the personal and emotional
meaning of experiences in the lives of people they instruct. Their ability to understand such
meaning is a part of the role that they play in their work. The story below is one of several
that indicated an understanding of the meaning of experiences in people’s lives:
First Aid is a very personal thing to these communities. They’ve had people hurt,
they’ve had people drown, they’ve had people burn in fires, so whatever topic you’re
talking about is bringing up memories and I think .. .that’s where you lose some
people if you don’t give them the time to talk. Or give them a break to go and get
themselves back together. ... I give them time to regroup themselves. And a lot of
times, the story will come out as to what the group was thinking. It’s usually obvious

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when a memory is triggered among two or three people. ... That’s a capacity
building thing because now they can talk openly about it. They’re in a group
situation ... you can resolve some issues. ... the first aid stops and w e’re on to this
topic....and then those groups really meld. You know, now this group has
experienced this thing together and w e’ve been able to talk about it together. (5A,
amended)
Understanding personal emotional meaning of events is facilitated by the ongoing
relationships that instructors have with the people in their classes and by awareness of the
history or experience that people have had. Both the relationships and awareness provide
opportunities to discuss the issues that can arise in the classroom setting or after an incident
such as the fatality identified above. Emotional issues can begin to be addressed and
resolved in a way that would not otherwise have been available to the people affected. The
skill and sensitivity of the instructor, as well as his/her knowledge of community history and
experience, enables them to be able to deal with such issues when they arise, to understand
the emotional significance of events in their respective communities and be able to work with
people in addressing the concerns that arise for them.
Building relationships
Many of the stories told by participants imply the building of relationships within the
communities of which they are a part. Building relationships was an aspect of capacity
building that was made explicit by some participants, as exemplified in the following story;
... for the ambulance crew, it’s just watching the rapport build between my crew, and
how they interact with each other. It becomes not only first aid teaching, it becomes
ambulance training. We work hard, sometimes in very difficult situations and if
you’ve been training with each other, it helps. Absolutely. (lOA)
The participant was not drawing attention to her part in building relationships, but it is
through the work done in first aid instruction and the subsequent work in ambulance service
that the relationships are built. This story also draws attention to the relationships built

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between different parts of community life. Capacity building in first aid instruction is
inseparable from capacity building in ambulance service. Living and serving in these two
areas of community life, the part played by the participant in building positive relationships
among people is a crucial one.
Living in relationship with community
The final area in which the health education worker role is played in capacity building
is one that I have called living in relationship with the community. Participants described
their work in ways that indicated that they were integral parts of the communities with which
they worked. The relationship is reflected in participants’ accounts of both their work and
the satisfaction found in the work, a satisfaction that is personal but that is gained from
awareness of the effect of their work in the broader communities of which they are part.
And so I can help them. I do extra time, and I don’t mind doing it because it does so
much for you. And they’ll come back quite often and say you taught me first aid, this
is what you taught me and they’ll tell m e.... that’s the nice thing about doing it long
term, not just dropping in and teaching. You can see the after effect and how people
use ideas you have taught them in their everyday life. (5A, amended)
One thing I find really self-satisfying basically is knowing that there’s people
scattered all throughout the Territory now that have first aid training that wouldn’t
have. (3B)
It’s also taking a core of knowledge and touching like so many people. I don’t know
how many courses that you have taught, but it must be numerous, and if you think
how many lives you’ve sort of touched within your camps and then going even into
the family setting, and even out into the public, so you take that knowledge and
spread it. (3C)
Contributing to and being valued in their work and life communities are important to the
participants. Seeing the benefit of their work over the long term is an additional bonus
available to people with ongoing relationships in a community. Their health education work
is a source of satisfaction to participants in living in relationship with their communities.

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Conclusion
The capacity building process included initiating and organizing activities for some
participants and, for all participants, included teaching. A key to capacity building is the
attitude and approach of the participants to the process. For instance, the flexibility that
participants bring to teaching, in preparing for and responding to the situations that arise in
the instructional setting is a significant clement in learning success for the people with whom
they work. The sensitivity, readiness to adapt to different learning styles, ability to recognize
and willingness to address issues important to the people they teach are all attributes of the
health education workers that can contribute to capacity building achievements.
In describing their role as health education workers, it became apparent that
participants contribute significantly to capacity building. Living in relationship with their
communities, the participants are able to initiate activity, they enable achievement,
understand meaning of experience of their fellow community members and build
relationships that facilitate capacity building. As individuals, they have built and are building
their own capacity. In offering service to their communities, they act as the bridge to
community capacity building. As increasingly capable individuals choose to contribute to
the broader community, community capacity building occurs. In so doing, the participants
are individuals who live the meaning of capacity building in the process of their work. Their
role is at the heart of the experience of community capacity building.

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CHAPTER SIX
A stepping-stone: Yukon context and effects of capacity building

Contextual factors and effects of capacity building activity were major themes of the
findings. The theme of context was separate from but relevant to the capacity building
process. The relevance of the Yukon context emerged in relation to the usefulness of skills,
credibility of standards and value of Yukon resources. The final major theme identified by
partieipants was the effect, outcome or result of their work, in their observation. The effect
includes the specific skills being taught but is beyond those specific skills. Findings on the
relevance of the Yukon context and effects observed by participants are described in this
chapter.
Influence o f Yukon context
Contextual factors are woven throughout the experience described by participants.
As has been noted, characteristics of the Yukon include small population centres, separated
by long distances and having limited infrastructure. People regularly find themselves in
situations where community services are too far away to be of immediate help in an
emergency. Such situations can arise when travelling by road between communities or when
living or travelling away from communities, as people would do for river trips, hunting or
fishing expeditions in remote locations. Participants spoke of three relevant contextual
factors tied to the experience of living in the Yukon. These factors, discussed below, were
the specific skills being taught having meaning in the Yukon, the skills having credibility
within and beyond the Yukon and the need to adapt resource materials to the Yukon context.

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Skills have meaning in the Yukon
For participants, capacity building is based on learning specific skills. Participants
noted that the skills that they teach are relevant in the Yukon context; they are likely to be
needed and used. One participant set the context for needing skills clearly:
Especially living in the Yukon and having these, especially living in rural Yukon,
these long distances from one town to the next, never mind the way to the hospital if
you live in Dawson, and it’s really important to know that you can do something if
you should come upon a crash or anything else. (7A)
The participant identifies factors intrinsic to Yukon life. In order to understand the reference
made by the participant, it is useful to know that Dawson, one of the largest communities in
the Yukon, with resources of a health centre and resident physicians and nurses, is a six-hour
drive from Whitehorse, where there are more resources. Implicit in the example above is the
high possibility of being the only person able to provide assistance in an emergency. As the
likelihood of a person needing first aid skills is great, developing those specific skills is
important in the Yukon context.
Some participants described the experience of using the specific first aid skills in
situations that arise in the Yukon due to long distances between communities and the limited
resources available in some locations:
I have recently taught a re-cert course where I used to w ork... a week or two later,
one of the staff there had to rush his w ife... to the nursing station in (a community 30
kilometres away) because she was having a, she basically had a miscarriage but with
lots of problems and he talked to me afterwards and said, “you know, when I had to
stop on the road because she went unconscious, it was like the whole first aid course
kicked in for me”. (3A)
I ran into a fatal head-on collision at (a named) Lake and I did all of the things. There
was nothing I could do for the one guy but I dealt with everybody else, right? So, it’s
the same thing. You’ve got the first aid training. Well, then you do something about
it when you’re there. (3D) (Note: The lake to which the speaker refers is on the
Alaska Highway approximately 300 kilometres from the nearest health care services.)

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These examples dramatically illustrate both the distance from other resources and the
consequent need for first aid skills. The person who had to stop on the road because his
passenger went unconscious recognized that only his skills could help her. The person who
helped at an accident scene knew there was no one else available to do so. First aid skills are
learned and used in the Yukon in a context where the likelihood of needing the skills is high.
Credibility o f skills within and beyond the Yukon
A number of participants identified the importance of standards for first aid education
in the Yukon context. Standards were seen as important because the Yukon is neither
isolated from the rest of the world, nor willing to accept a lower standard of emergency care
than elsewhere. Standards ensure confidence that education will he consistent, of good
quality and credible within and beyond the Yukon, as described below:
We know the instructors are current; we know how they’re teaching them. ... not
anybody can just go teach a Standard First Aid class any way they want to. There is
quality out here. There are standards to follow. (IB)
...our connection with national agencies enable people to get trained here and have
certificates that are valid inter-provincially, inter-territorially. (lA )
Standards ensure that there is a consistent level of competence associated with various levels
of certification. Credentials that are recognized through national organizations are one way
to ensure that the skills being developed are credible both within and beyond the Yukon.
Standards for education ensure that the knowledge that people gain is credible to others,
whether that knowledge is applied in the home community or elsewhere in the country.
N e e d to a d a p t re so u rces to Yukon co n tex t

Due to differences between the Yukon and other Canadian locations where first aid
skills are taught, partieipants indicated that there is need to adapt resource materials to ensure

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that they are useful in the Yukon context. This was identified in one discussion about the
limitations of the course content because of its urban orientation, as follows:
We get a lot of comment about the course, because the course is urban-oriented. (3D)
I was going to say, it’s a little limiting in that. (3C)
For us, w e’re always getting questions about, well, it’s like three hours to tow n...
And, you know, the whole premise of our course is that, well, EMS (Emergency
Medical Services) is going to be there in five minutes or less, right? (3D)
We have 20 minutes to wait for an ambulance and it’s a long time to wait for an
ambulance. And I know when I did the babysitting course and I did it with the kids
who were just out of town, it doesn’t touch on anything in the rural setting, so when
you’re trying to teach the kids what to do, it’s all urban, and as an instructor, I felt
very uncomfortable with it because I didn’t feel I was giving them enough knowledge
to handle a situation. So it’s easy to say, pick up the phone and dial 911, but even
some of the kids are not within the 911 area. (3C)
...A nd you know, we put our own little twists on it about, because w e’ve all got the
radios and everything in the trucks and you Just do your continuing care kind of thing,
basically, and that’s about all you can do. So you just try and put your little twists on
it and still kind of stay to the curriculum of the course. And explain that this (the first
aid curriculum) is designed as an urban teaching. This is for an urban environment.
(3D)
The discussion illustrated the need for and challenge of adapting the resource materials and
content of teaching to ensure that it can be applied in the Yukon context. The course
curriculum, valued because of its national credibility, has a strong urban orientation. This
urban orientation limits the practical value that standard first aid programs have in the Yukon
context unless people can make adjustments to the settings in which it will be used.
The participants observed the value of using resources that are relevant in the
Yukon context. One way this is done is by sharing useful information.

And I think here, too, that even just amongst all the instructors (we) have been
building a little reference library of so many things here that you’ve got all sorts of
options to do any number of things you want to do for any given group ... If you
want to modify a little bit for a given group of people or whatever, well you’ve got all

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sorts of materials here to work with. And that’s all stuff that I think mostly all the
instructors have supplied to Public Health and Safety. (3D)
Participants share information that they have found useful for teaching in the Yukon context,
in order to help each other adapt to the needs of different groups.
Participants also found that resources that were ‘made in Yukon’ helped them in their
teaching. Recognizing a face in a book could make material more relevant to a learner.
But I guess the example is we know and we hear it from instructors and we hear it in
the office that, boy, it would be great to develop some ‘made in Yukon’ resources,
such as video resources, the book was a good example. (Speaking of First Aid fo r
Everyone, a first aid book that was developed in the Yukon) ... people who use that
book go, wow, hey, I know this guy. You know, in the picture. And suddenly it’s a
lot closer to home. And it’s a great book. Like it’s not like something that was just
put in a duo tang or something. It’s a professional book. And I think you could have
video resources that are the same. (3 A)
In the experience of participants, there is need for resource materials that are relevant to the
Yukon context because of the limitations of urban-oriented course content. To this end,
participants adapt urban-oriented resource materials to the Yukon situation, share resources
that they have found useful and rejoice in the existence of Yukon materials when they are
available. The resources used in first aid education are of greatest practical use when they
are adapted to the Yukon context.
Ejfects o f capacity building
Effects were identified in relation to capacity building for individuals; links were also
made between individual and community capacity building. Effects of capacity building
seen by participants are described in this section, first as individual effects and then in the
link between individual and community effects.

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Individual Ejfects
The discussion of the application of first aid skills in the Yukon identified the value of
the skills being taught. In addition to the benefits directly related to the skills being taught,
participants identified outcomes gained by individuals beyond those immediate skills,
including increased awareness and practice of safe and healthy choices, increased confidence
and self reliance and, for some individuals, using the first aid experience as a stepping stone
to future achievements. Each of these effects is discussed in this section.
More safe and healthy life choices. Increased awareness and practice of safe and
healthy choices by individuals was an effect related to but going beyond the first aid skills
taught. The examples below describe a process of increasing awareness that led to changed
behaviour in situations as diverse as safety practices on the ski hill and healthy eating
practices:
So when it comes down to attitude changes, one of the biggest ones that’s happening
right now is the use of helmets for people. I know that the year that I started, I got a
helmet and I think there were two others that were helmeted at the end of the season,
and now we’ve probably got about 67% of the crew that wear helmets all the time,
and the result of seeing most of the ski patrol wearing helmets now is that w e’re
seeing more adults up there that are helmeted and we’re insisting that the rental
facility provide helmets as well. (6B)
I go baek to (a particular group) again because I’ve been there twice now. During the
first aid course, we did quite a bit of teaching about eating properly and heart attacks
and high fat diets and that kind of a thing, and within that one course, the first one, we
moved from having Kentucky Fried Chicken for lunch the first day, to actually
having vegetables and dip and really healthy stuff the next day. And that was
interesting. But then, when I came back about six months later, actually that was still
in effect, so people were still talking about eating healthy, looking at the carrot sticks.
...W e made it a joke and everybody was teasing each other and w e were really

looking at what everybody was having for their meals and came back the next day
and talked about what we had for supper even, and that carried through. Now, that’s
a very small group of people, there weren’t all that many people there, but it did carry
through to the next time. (6A)

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Awareness about safe and healthy choices may be a first step towards change of behaviour
that can subsequently prevent problems such as accidents and injuries from arising in future.
The experiences cited indicate that effects were seen beyond raised awareness to changed
practice. In both these examples, awareness has led to specific behaviour change to increase
safe practice or to eat more healthy diets. Safety is highly relevant to health status in the
Yukon, where the rate of death from accidents and injury for males is more than three times
the national average. (Timmermans, 1999;Yukon Health and Social Services, 2003b).
Raising awareness and encouraging safer and healthier practices could influence long-term
health outcomes in the Yukon. Thus, while gaining knowledge and skill generally is capaeity
building, gaining it and applying it specifically in the area of health and safety is part of a
circle of influence on health, safety and well-being.
Confidence. Increased self-eonfidenee or self-esteem among individuals was another
effect observed by participants. Several partieipants identified increased confidence as an
outcome that occurred as individuals gained and practiced the specific skill being taught.
The other thing, too, if you’re looking at eapacity building, there again, not only are
they learning the first aid skills but they also learn the confidence.... they need to be
able to stand up and speak; they need to be able to take control of a situation; and
that’s what part of first aid is, is that, OK, you have a problem, I recognize the
problem. It’s safe for me, and you go into the scene. How bad is this problem? And
then they have to specifically tell somebody to get help. You know, like, you in the
pink shirt go. They have to take control over it, so that they are learning, I guess it’s
confidence. (2B)
I’ve noticed with some of the more unique groups, like the WCC (Whitehorse
Corrections Centre), the Corrections, or like the Youth Achievement Centre, that
som e people are surprisingly, to them selves and maybe to the people around them,

good at what they’ve done and didn’t realize they had this sort of natural ability to
pick this up and I think that that’s been a really inspiring thing for some people,
especially with the encouragement of an instructor saying, “Wow, you’re really good
at something like this. Have you ever thought about getting in to teaching first aid
yourself or a career in health care or something like that.” I think that, when someone

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can learn and feel good about what they’ve learned, it does build confidence and
boost self-esteem. (9C)
The increase in confidence is closely tied to the specific skills being learned, but builds on
those specific skills to develop personal competence that can be applied in other areas of life.
Learning how to assess and take control of a situation and to direct others, as described in the
first example, can build confidence that can be applied in other circumstances. Likewise, an
accomplishment, recognition of the accomplishment and encouragement to take further steps
developing on that accomplishment can open the possibility for achievements in life that an
individual may not previously have contemplated. Such an experience is consistent with the
meaning of capacity building with respect to building on strengths and opportunities and
facilitating empowerment, as discussed earlier. The long-term outcome of increased
confidence or self-esteem was not described by these participants; in many cases, they may
not have an opportunity to observe the long-term effect, but have been able to observe that
the effect is fairly immediately seen beyond the specific skills being taught.
Self-reliance. Another capacity-building effect that is related to but goes beyond the
skills being taught is increased self-reliance. Participants observed that increased self-reliance
for individuals is one of the outcomes that can arise from first aid teaching in relation to
caring for themselves and their families.
I think self-reliance in medicine is so important. It’s also, I find this with our own
crew here, people understand their own medical conditions better so when they deal
with their own physician, their primary care doctor, they can communicate better with
them. (8A)
People come in and say, “ I did this, I tried this. This is what they told us in the first
aid course.” And they will put pressure on it or they will wait until the morning if it’s
a small cut, and just have it checked out, rather than running in panic to the health
centre. Fevers for children - people can take care of a fever for a child rather than
calling us up and saying, “what do I do?”. They know they can give Tylenol, they
know they can bath them down, whatever it takes. (5A, amended)

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The value of self-reliance has been identified in the Yukon context as being important in
order to cope with situations where other help may not be available. The ability to
communicate with health providers about health and the ability to be independent in
managing health problems are reflections of self-reliance that participants observed. Selfreliance is seen in the increased knowledge that people apply in looking after their own
health and that of their families. Increasing the capacity that people have to exercise
independence in managing their own lives and in caring for their families arises from the
specific skills that individuals have learned but extends beyond those skills.
Stepping-stone to future achievement. In some instances, participants observed
effects that were not linked to a particular attitude, skill or knowledge, but to a more general
experience of empowerment, subsequently leading on to other accomplishments. Several
examples indicated that individuals have used first aid education as a stepping-stone to future
achievements.
W e’ve got people that started when I did or after I did that are now working with the
ambulance service. They’ve taken it as a stepping-stone. They’ve had that interest
and they’ve gone on. (6B)
And we’ve had more people go on from there. We had one teenager who was kicked
out of school, and thought that he’ll never do anything well. They put him in the YES
program, Yukon Employment Strategy program, and in one of the first weeks he was
to do this first aid course ... he was the best student I have ever had. He couldn’t read
well but somebody had helped him read the book, he had learned to do this stuff and
he did better bandaging than I did. And he was so proud. He is now a carpenter in
town. And he’s great. ... But this was the first certificate he’d got. He told me “It
was the first thing I’ve ever done and finished”, so (there is) that incredible sense of
accomplishment that com es from doing the first aid course and getting through it
successfully. (5A, amended)
A step to future achievements is attributed to providing an opportunity to succeed at
something in life, sometimes for the first time. The step may provide an opportunity to

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pursue an interest in emergency care into a career in the same field or it may provide an
opportunity to demonstrate strengths to oneself and others and, in so doing, recognize that
one has strengths that can be further developed in another field of endeavour.
The capacity building effects for individuals occur among people who may not have
had many previous successes in their lives. The examples included references to people in
jail, people who could not read well, people who may not have seen themselves as being able
to do something and finish it. Participants spoke of observing changes in health and safety
practices, in ability of individuals to care for themselves and their families and of people
being empowered to go on to achievements beyond those made in the first aid classes.
Linking individual and community capacity building
How is the link made between building individual capacity and building community
capacity? The findings shed light on this question in relation to individual choices, social
responsibility and community service. The findings are discussed below.
Individual decisions. Participants indicated that building community capacity
consistently starts with an individual and is taken to the community level according to the
choices made by the individual. One participant spoke of this in a general way, another
spoke specifically about the experience of instructors in making their own individual
decisions:
We end up, I guess, influencing individual capacity and community capacity by the
individuals themselves who are the ones who learn that, “hey, I can do this. I really
like doing this”. And then that kind of communicates and that builds on itself, so you
know, I really see it as building individual capacity and comm unity capacity and

where that goes is really up to the individuals and the people in the community. But
you can see it often goes a long way and it’s quite interesting to watch. (IE)
I’ll also say that by having people throughout Whitehorse and the Yukon coming to
take, for instance, our instructor course, they can then take that back to their
community and be self-sufficient, whether that community is their place of work.

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where they just train their own workers ongoing, or if that eommunity is (a partieular
community) and they can keep the volunteer ambulance regularly re-certified in CPR
or something like that. (lA )
In the latter example, the individual making the decisions to apply their skills in their
community is the health education worker. The choice that he or she makes about when,
where and how to apply their skills in their community is autonomous. Their decisions
exemplify the role of individual choice in contributing to capaeity building in a community
and the integral role of the health education worker in that contribution. The workers decide
when and how often they will teach, and to what groups, within their level of certification.
Individuals gain skills, belief in their abilities and enthusiasm about having and using those
abilities. The skills and attitudes that exist as potential to be applied in the eommunity are
developed according to the interests of the individual. The progression from individual to
community eapacity building is illustrated by the experience of people who gain instructional
skills and knowledge and then choose to apply their knowledge in community service.
Social responsibility. Another effect of capacity building seen at the community level
is an increase in social responsibility, understood to mean a sense of serving a collective
social good beyond the individual. Participants described how they have seen growth in both
the understanding and application of social responsibility in their communities.
You just have to get the message out sometimes, what social responsibility is. And
what it’s about and how you can do it. And it doesn’t have to be a big thing. It’s just
little bits of stuff at a time. And if it’s driving by somebody’s house who’s in the
course, stop and see if they need a ride, you know, simple things like that. If they
have to walk and you don’t, you have a car, stop and see if they want a ride. (5A)
... the obvious turnout for the fire workers this last two weeks has been amazing. I
mean all these people putting in ten-twelve hour days doing patrols here and on
standby for fire because it’s so hot. It’s a lot of energy. W e’ve had, well since a
week ago Monday, I think w e’ve had three or four people on duty every afternoon
and evening until late . . .and people are still starting fires. ... well, they (the

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volunteers) wouldn’t feel comfortable doing a lot of this stuff, being out all the time,
without having the first aid, CPR training. (8A)
In these examples of social responsibility there is a conscious orientation to the well-being of
others. That orientation can be shown in informal ways by people learning to support each
other in attending classes in very practical ways such as providing transportation or in more
formal ways such as volunteer fire fighters in enforcing a fire ban during a period of extreme
fire hazard in the Yukon. In both examples, participants observed that people were willing to
dedicate time and take on responsibility for the well-being of others in their community.
Community service. Community service is understood as structured involvement of
individuals with a community. Participants identified community level effects of capacity
building in a number of areas that have already been mentioned, such as providing volunteer
ski patrol or fire fighter service. However, community service effects were identified most
frequently in relation to providing volunteer ambulance services.
We see in the first aid end people becoming involved with ambulance in their
community. .. .once they take the advanced training, they realize there’s a door, a
potential there that they can go in and serve their community. (lA )
There’s several people that have taken the class and then decide to join (the
ambulance service). Not a lot, but somewhat. (8A)
Throughout rural Yukon, ambulance services are provided by volunteers. Because
communities are widely scattered, this can mean that volunteer ambulance crews must
respond, usually with the assistance of a community nurse practitioner, to any emergencies
that arise over a vast area.

People involved in emergency situations rely on ambulance

services to provide immediate life-saving response, stabilization of conditions and
transportation to more advanced medical services. As such, volunteer ambulance service is

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of great value to people who live and travel in the Yukon. The effect of capacity building in
enhancing community services can thus be one of particular consequence in the Yukon.
Summary
In examining the effects of capacity building in the Yukon, outcomes have been
identified by participants at both the individual and community level. At the individual level,
the effects are related to the skills taught by the participants, but go beyond these to influence
safe and healthy lifestyle choices, and increased confidence and self-reliance. Empowerment
effects may be seen in a general ‘opportunity to blossom’ or more specifically in using initial
achievement as a stepping-stone to future achievements. At the community level, both
process and effect of progression from individual to community has been identified in
expanding the circle of influence. Effects are seen at the community level in increased social
responsibility and in provision of community service. Participants see the effects of capacity
in observing people building on strengths and opportunities to become empowered in ways
that contribute to their own and their community’s health and well-being.
Conclusion
The experience of capacity building described by participants indicates that the
practical need for and use of specific skills, the credibility of those skills within and beyond
Yukon communities and the use of appropriate resource materials are all relevant in the
Yukon context. The experience described by participants indicates that behind the specific
skill development in first aid, there is orientation towards being prepared for self-reliance in
emergencies, towards coming to the aid of others when needed, towards adapting actions and
resources to the situation and towards creating and sharing useful resources. The specific

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skills, the standards and resources applied in developing skills and the context in which they
are developed are closely intertwined in building capacity in the Yukon.
Capacity building was seen as going beyond specific skills being taught by the
participants but it also includes those skills. In the Yukon context, among the group of
participants who were primarily first aid instructors, the specific skills taught are important.
They are likely to be needed; they are often used. Gaining competence in specific first aid
skills contributes to empowering people in self-reliance and self-care. For individuals,
participants observed that the effects of their capacity building work goes beyond the specific
skills to include influence on healthy lifestyle choices, increased confidence and self-reliance
and influencing steps to future achievements. Individual actions move capacity building to
the community level, ranging from influence on family and friends, to increased social
responsibility to more structured activities of community service in areas such as ski patrol
and volunteer fire and ambulance service. In the Yukon context, the reach of capacity
building goes well beyond the skills taught and learned, but is grounded in them.

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CHAPTER SEVEN
What does it all mean? Summary and implications

Three dominant themes emerged across the discussions of meaning and experience of
capacity building, each reflecting a focus study participants identified as important. One
theme is building on strengths, a second theme is achieving an end of immediate importance
within the context and the final one is living in relationship with the community. These
themes are explored, then implications for capacity building policy, practice and future
research are discussed.
Themes
Building on strengths
Participants understand and practice capacity building in a way that builds on
strengths. This focus reflects the belief that strengths exist, and practice that recognizes and
augments those strengths. With this focus, capacity is enhanced rather than built.
Participants assume that there is a foundation of capacity that can be expanded rather than
built from scratch. In their work with jail inmates and people of low literacy, people who
might otherwise be disempowered, participants found that capacity building could happen
whenever people were open to learning. Where opportunity exists or is created, strengths can
be expanded to empower people in the Yukon context. This theme was identified in relation
to the meaning, practice and outcomes of capacity building, as discussed below.
M ean ing. The understanding o f eapaeity building articulated in this study includes

the four key concepts of building on strengths, building on opportunities, achieving an end of
importance in a community and having effect beyond that end. In comparing this
understanding with the meaning of capacity building articulated by other writers, these

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concepts are shared most closely by Labonte et al. (2002). Although the concept of building
on strengths is consistent with the meaning of capacity building articulated by other writers
(Kretzman & McKnight, 1993; Labonte et al.; 2002, Restrepo, 2000; Smith et al., 2001),
participants in this study placed a more explicit emphasis on this concept, moving towards an
understanding of capacity enhancement rather than capacity building.
Practice. The role played by the health education worker gives expression to the
meaning of capacity building. It is the health education worker who has the knowledge
required to build on strengths, and the relationships that facilitate interaction with others to
achieve an end of importance in the community. Participants could build on strengths such as
valuing self-reliance or skill at bandaging or work with others to offer programs in ways that
would be most effective in their communities. The ability to recognize and respond to
strengths highlights the role of the health education worker in bringing the concept of
capacity building into practice.
Outcomes. Participants observed strengths growing among community members as
an outcome of their work. One participant described this growth eloquently as a bud
gradually opening to more sunshine. Participants observed effects that were broader than
acquisition of the specific skills they were teaching. They saw capacity built with respect to
individuals making healthy personal life decisions, ranging from safety practices to career
choices, and with respect to increased confidence and self-reliance. Participants also saw
effects that reached beyond the individuals they teach. For instance, they observed that the
people they have taught may be better able to care for their families, may take greater social
responsibility towards their fellow community members or may become involved in
community service work, such as volunteer ambulance or ski patrol programs. Although the

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health education workers described the process of their work as being undertaken with
individuals and small groups, they sometimes saw that work blossom in the community.
Outcomes included enhanced strengths at the individual, family and community level.
An additional point to be made about capacity building practice is that participants
experience the outcomes in their own lives as well as observing outcomes among others.
Like the people they work with, the health edueation workers blossom in their work.
Participants spoke of their satisfaction, for instance, in knowing that they have touched many
people through their work, in having greater value to their employers because of their skills
and in the pleasure they take in seeing positive change in their communities. The participants
experience the outcomes of capacity building in their own lives as well as facilitating those
outcomes for others. Participants build on their own strengths, as well as building strengths
in the communities of which they are part.
Achieving an end o f immediate importance
Although the potential of capacity building to deliver health gains on a wider front
than the health problem of interest has been recognized (Hawe et al., 1997), this study
indicates the importance of focussing on the immediate end. The immediate end is the entry
point to achieving wider gains. Achieving an end of importance was a theme that emerged in
discussion of meaning, practice and outcomes of capacity building.
Meaning. To participants, the meaning of capacity building included building on
opportunities to achieve an end of importance in a community. This end of importance is
similar to addressing a need or health issue, included in the definitions articulated by Smith et
al. (2001) and Labonte et al. (2002), but approaches this from a different direction. Although
there is some focus on a deficit in the community, such as a need for standards in ambulance

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service, there is also focus on achieving an end of importance in the community, such as
enhancing ability to care for children in an emergency. The immediate end is the focus that
engages participation within a community.
Practice. In initiating programs, the health education worker may have an integral
part in articulating the end desired by a community and in finding a way to achieve that end.
The health education worker is part of the capacity building gains, not separate from them.
Participants were involved in continuous learning, acted as resources in their community and,
in so doing, helped to achieve ends of importance within that community.
Acquiring skills in first aid is an end of importance in the Yukon context. The
likelihood and experience of using the skills in isolated situations far removed from other
sources of help reflects that importance. Capacity building literature sometimes emphasizes
achievement of ends beyond specific skills that enable people to address determinants of
health and to improve health outcomes (Bopp et al., 2000; Hawe et al., 1997; World Health
Organization, 1997.) While the longer-term goals of capacity building are important, this
study indicates that the immediate skills gained or learning achieved are the grounding from
which wider ends can be achieved. Ensuring that that the immediate skills or learning have
relevance in the context is an important entry point to enable the longer term ends to be
achieved.
Outcomes. In addition to the outcomes that build on strengths, participants indicated
that outcomes achieve the end of influencing determinants of health. Education, in this case
in first aid, is a determinant of health in and of itself. Outcomes such as increased confidence
and self-reliance and community level involvement extend beyond immediate achievements
into the realm of health determinants.

To the extent that people become more able to

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control their personal health practices and their soeio-economic and physical environments,
influence on determinants of health is aehieved. Through their practice, participants affect
determinants of health, consistent with the understanding of capacity building articulated by
other writers (Bopp et al., 2000; Hawe et al., 1997; World Health Organization, 1997). The
outcomes described by participants affirmed the ability of a capacity building approach to
address determinants of health. This is an end of importance.
Living in relationship with the community
The health education worker, living in relationship with their eommunity, is at the
heart of the capacity building experience in the findings of this study. It is this relationship
that makes possible so many of the achievements in Yukon communities. This focus is
manifested in the practice described by participants, by the understanding brought to practice
and by the organizational support.
Practice. The participants bring sensitivity to, and sensibility of, the experience of
Yukon people to their practice. Participants have knowledge of their communities; they use
this knowledge to achieve ends of importance. They build relationships, provide leadership
and create opportunities to build their communities. The research participants are living the
meaning of eapaeity building that they articulate; they build on their own strengths as well as
those around them, they build on opportunities to achieve ends in the interests of their
community, they are empowered themselves to reduce reliance on resourees outside the
community. As their capacity is enhanced, they, in turn, apply their skills to facilitate the
empowerment of others. In this study, it is through the relationships built by the health
education workers that capacity building in Yukon communities occurs.

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The relationship with the community is reflected in the sensibilities brought to
participants’ work. Understanding and respecting the experience of their respective
communities enables workers to approach teaching situations effectively. The respect
shown by the health education worker towards the experience of a community death, for
instance, can enable learning to continue as a group works through emotional issues. In less
dramatic ways, workers organize program delivery and prepare for teaching, recognizing and
acting on the understanding that workers maintaining their required first aid credentials
requires a different approach than teenagers taking a program for the first time.
Understanding and respecting community experience enables capacity building
achievements. Others have noticed that health promotion workers working in interactive
relationships with community members is integral to capacity building practice (Hawe et al.,
2000; Smith et al., 2001; Labonte and Laverack, 2001a; Crisp et al., 2000). The role of the
health education worker living in relationship with the community particularly distinguishes
capacity building practice in this Yukon study.
Organizational support fostered the ability for participants to engage in capacity
building practice. The Yukon College Public Health and Safety organization supported the
health education workers by providing opportunity to gain skills, by providing the freedom
and opportunity to apply those skills and by supporting the workers in applying the skills by
using their abilities to teach others. Support was also provided through ensuring that the
worker’s education enabled program standards to be achieved and maintained, through
provision of administrative support to organize classes and through provision of resource
materials to support activity undertaken by health education workers. Organizational support
facilitated capacity building activity undertaken by participants.

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The role of the Yukon health education worker in relation to the community appears
to be a more complex relationship than that anticipated by writers who see different actors
with different purposes (Labonte and Laverack, 2001a), or different activities at different
levels (Hawe et al., 2000). The practice of capacity building described in this study
incorporates the different approaches identified by Crisp et al., 2000, though the approaches
were not found to be mutually exclusive. One practitioner may simultaneously undertake
activity involving Crisp et al.’s top-down, bottom-up, partnership and community organizing
approaches. Participants said that they may play several roles, at different levels within their
communities and employ a range of approaches in doing so. The roles, levels and
approaches identified by others overlap and conflate, reflecting the multi-faceted relationship
of Yukon health education workers with their communities in capacity building practice.
Conclusion
The focus on strengths is part of a philosophical framework that frames interaction
among the various players involved in the work of the Yukon College Public Health and
Safety unit. The players, whether they be employees, network members or people attending
programs offered by the former groups, act and interact such that people at each level are
able to gain power to achieve outcomes of importance to them. This enables the application
of means to achieve outcomes, consistent with the ideas put forward by Giddens (1993). By
focussing on strengths, a means is found to enhance people’s power to achieve ends of
importance to them.
In their interactive relationships with their communities, within a context of
significance provided by the intended ends of their activity, participants counter the
individualism that disconnects us within our world. In their words, the participants provide

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hope that the societal malaise described by Taylor (1991) may have an antidote. In
facilitating empowerment, participants counter the political fragmentation and powerlessness
of concern to Taylor. Through their work and the work of others with whom the participants
live in relationship in their communities, the vicious cycle of societal malaise shifts away
from individualism and disempowerment towards a virtuous circle, moving people toward
successful common action.
Implications
The study findings point to implications for policy, practice and research. The
implications below are drawn from the themes focussing on strengths, relevance in context
and relationships.
Implications fo r policy
Organizational policy support can facilitate capacity building activity. At an
organizational level, such support starts with a deliberate and conscious intent to undertake
capacity building. From that philosophical orientation, organizational policy can enable
capacity building through commitment of funding and resources. Findings of this study
indicates that systematically focusing on developing the strengths of people within
communities involves recruitment of workers from within communities, supporting
education and professional development for those workers, providing resources such as
education materials and equipment to facilitate their work and assisting with administrative
functions such as registration and arranging for teaching facilities. These findings point to
the spaces where policy can support capacity building. In respect to human resource
planning, for instance, policy can support actions such as identifying prospective workers
from within communities, initiating skill development among community members.

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providing opportunity for community members to apply those skills within their
communities, and supporting ongoing professional development. Organizational policy can
deliberately model the capacity building role of health education workers through processes
such as initiating activity, enabling achievement, and building relationships, all of which
have been manifested in this study.

Organizational policy can further support capacity

building through ensuring that administrative services and teaching resources are available to
their workers. Such support can enable community people to become resources building
capacity in their communities, as the participants in this study have done.
A more subtle policy implication is the potential value of conscious awareness of the
capacity building roles undertaken by community workers. In this study, capacity building
was an unfamiliar concept to most participants. Increasing awareness of their potential to
have influence on health determinants beyond the specific skills being taught may enhance
the ability of workers to achieve such influence. Bringing such information into the
foreground of awareness could, at least, be a way of acknowledging the contribution made by
workers towards enabling people to experience more control over decisions that influence
their health and lives. Thus, a policy implication would be to purposefully incorporate
awareness of the understanding, approaches and processes that contribute to moving from
immediate ends to more long-term gains, that is, to playing a capacity building role.
This study did not produce evidence that community capacity indicators would
provide useful information about the impacts of capacity building practice. Capacity
building activity outcomes will not likely be measurable at a community level, though the
activity may contribute to improved health status and have a positive impact on determinants
of health at an individual level. While policy makers need to establish the legitimacy of

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capacity building activity for multiple reasons that have to do with system or organizational
funding, support and accountability (Labonte & Laverack, 2001; Smith et al., 2003), there is
risk in trying to link capacity building activity and the achievement of community capacity
too closely. The evidence gathered in this study indicated definite and positive change for
individuals and similar influence on some areas within the community arising from capacity
building activity. The capacity building activity did not, however, require a minimum level
of community capacity as a precursor to action nor was there necessarily indication of change
in capacity at the community or collective level as a consequence of that action. Outcomes
of the activity were often observed at a subtle level unlikely to be revealed by measurement
of community capacity indicators. For instance, it is unlikely that community capacity
indicators would be able to determine that emotional issues arising from injuries or deaths
have been resolved among some people in Yukon communities, and yet such outcomes were
described as occurring and being important among groups with whom participants worked.
At the policy level, this means that the outcomes of a capacity building approach will need to
be assessed qualitatively rather than through indicators of community capacity.
Implications fo r community health practice
Although organizational support can facilitate capacity building practice, community
health practitioners can take a capacity building approach to their work in communities
regardless of the extent to which such support exists. In their relationships within their
respective communities, practitioners develop an understanding and appreciation of the
context in which they work and of what is important within that context. The relationships
inform the ability to identify changes that can be achieved and to effect those changes.
Practitioners can use their knowledge to achieve ends of importance in communities that

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have potential for broader impacts. A capacity building approach can enable community
health practitioners to impact the determinants of health for people in their communities.
Implications fo r research
Further research is needed to determine where we should be looking for measures of
the success of capacity building, since, as a society, we require such measures to justify
resource allocation.
Research into and subsequent measurement of capacity building outcomes, if pursued
in the Yukon, could be of potential benefit if done in a way that is sensitive to incremental
changes moving from individual to community levels. Systematic qualitative assessment of
outcomes by practitioners may be a useful approach to improve understanding of the effect of
a capacity building approach. Such assessment could be useful to organizations in
understanding the effect of capacity building and in providing justification to support such an
approach.
More work is needed to clarify and distinguish between capacity building and
community capacity concepts, the indicators required and the appropriate measures of those
indicators.

Labonte and Laverack (2001a) create a bridge between the two concepts in

recognizing the role of capacity building in impacting determinants on the quality of
individual lives “if not also of communities healthy functioning” (p . 112). While both
capacity building and community capacity building are recognized as including elements that
are ends in themselves and those that are means to an end, work is needed to further
distinguish the concepts and clarify the relationships between them.

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Limitations
The study has been undertaken with practitioners working in the field of health
education outside of the health care system. No conclusion can be made about the potential
for the knowledge gained in this study to be applied successfully within the health care
system, or for that matter, whether it is already being applied. Further research would be
required to shed light on those questions.
This study gave some suggestion that health status indicators may be affected by
capacity building activity. For instance, specific mention was made of increase in safe
practices, a behaviour change that could contribute to lowering incidence of accident and
injury within the Yukon. Also, the ability to respond effectively and promptly to accidents
when they do occur will potentially benefit health status by reducing the extent of injury or
lasting harm. Although the examples of possible influence on health status indicators arose
from the first aid skills being taught by participants, taking a capacity building approach to
different skills could have potential to affect health status indicators over time. Combining
capacity building approaches with other strategies could create a comprehensive approach
with potential to change health status indicators. In this study, it is not possible to determine
health status impacts in the absence of causal links and in the absence of data on accident and
injury rates. The health education workers provided a glimpse into some of the areas where
health status indicators could be affected by capacity building.
Although the complex Yukon political environment was identified as one of the
relevant contextual elements in planning the study, political issues did not arise in
discussions of capacity building at the community level. This is not to say that political
elements do not exist or do not need to be addressed, but simply that this study did not

105

produce findings in relation to political considerations. Policy and resource support for a
capacity building approach could be mobilized at the political level, but could often be
undertaken within organizations without requiring political level endorsement. The capacity
building experience described in this study appears to fly below the political radar, using
organizational support and community members to undertake activity and achieve outcomes
with individuals at the community level.
Conclusion
The last word belongs to the health education workers who made this study possible.
After reviewing quotes and interpretation, one participant commented that:
My experience working with Yukon communities ... tells me you've hit on the very
crucial components of capacity building...knowledge, skills, values, credibility and
empowerment.
Such affirmation from people at work in capacity building helps assure me that the study is
credible and well grounded. It is my hope that this research will provide insight into capacity
building practice such that it can continue and expand to effectively move us towards
improved health outcomes for the people of the Yukon.

106

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Appendix A
Interview question guide
Questions by theme
Theme - Meaning of capacity building
What do you understand the term capacity building to mean?
How do you see capacity building as being part of your work?

Theme - Process or steps in capacity building
When you are undertaking a capacity building activity, how do you go about it? What are
the things that you do that are part of an activity?
Can you describe a time when you engaged in building capacity? How did it come about?
Who was involved? How did they become involved? What did you do? What did others
do?

Theme - Outcomes of capacity building
What have you seen as a result of capacity building? For instance, what changes have you
seen in individuals, groups or relationships between people?
What would you consider to be a sign of success of capacity building that you have seen?

Theme - Facilitators, dilemmas, issues for workers in capacity building
What have you found helps when you are involved in capacity building? Consider this in
relation to things that make this work easier in the community, the organization, among the
people you are working with, or other things that come to your mind.
What makes it hard for you to be work in capacity building? Consider this in relation to
barriers that come up for you in trying to do capacity building work.
What are the issues that come up for you in doing capacity building work? Consider this in
relation to your personal experience in the work, and in relation to factors in the broader
environment that affect your work.

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Appendix B
Sample section of data management table
Outcomes
Description

Sub
heading

#

Example

Discussion

Skills that
can be
applied,
and
readines
s to apply
them
when
needed

ID

I think an outcome is like life skills. Like these are
life skills we provide and no matter whether it’s
being just even with the breakfast program, we
provide them with a life skill. They funnel it
through the children. We teach them life skills. So
it all ends up, there’s as an end result. Whether you
get training or you’ve learned something new that
you can take into your life, because I mean, first
aid, then you provide a skill anywhere, anytime,
that could be necessary or needed, whether you’re
on the soccer field, at home and your child falls
down, or behind that car that’s in a bad car
accident, like these are sometimes necessary things
in life and whether it’s preventative or Just assisting
later.
It’s not just about first aid. It’s also a different
avenue for people. It’s not, it’s a lot of practical
stuff. I mean, you can do first aid, you can teach
first aid, simply hands on. I mean it’s, having the
notes and the videos and all that kind of stuff is
nice, but it’s possible to teach somebody hands on
and they can see an outcome because there’s a
product. You know, like if you bandage a hand,
there’s a bandaged hand and it looks good, and it’s
sort of immediate. In other ways, there’s, like quite
often I’ll do first aid, sort of a quick course but with
kids, right? And because it’s, I guess because it’s
hands on, they’re there and they learn and they pick
it up and they retain it, and it’s something they can
do in the field.
The other thing, too, when you’re doing, for
instance, the Heimlich manoeuvre, the choking
aspect, it’s amazing how many people said, oh,
well, I actually did it and it actually worked, so they
have basically saved these people’s lives.
And the other thing, too, a while ago there was
somebody having a heart attack. Well, there were

Life skills

Personal
Practical
Skills that
can be
applied, and
readiness to
apply them
when
needed

2A

114

3C

3D

3D

4A

5A

5, 4 or 5 people right there ready to do CPR and
they knew how to do it.______________________
(skills are) Not (always applied) in the workplace.
Fm just thinking with our workplace, all of these
people are trained so that, if we have an emergency,
Fm the person that’s called.
Rescue stories and like, I know, we had just
finished a course and one teacher was in having
lunch with her kids, and one child ran to the
bathroom and she followed and the little girl was
choking. And she had said, oh, you know, I did the
thrust and out it came, so it was sort of one of these
success stories that happened. So that’s sort of
where I see the staff going.

You know, they’d be more apt to jump in, in a
situation because they’ve had some sort of training,
right?________________________________________
I ran into a fatal head-on collision at xxx Lake and I
did all of the things. There was nothing I could do
for the one guy but I dealt with everybody else,
right? So, it’s the same thing. You’ve got the first
aid training. Well, then you do something about it
when you’re there. There was a few people drove
by, you know. I was the first one there, so a
different kind of story maybe. It’s hard to say, but
some people drove by because they don’t know.
.. .you know, if you know what you can do to stop
something and you know what you have to do if
something happens, you understand a little bit more
the implications of an emergency situation, and I
think overall people are just more prepared._______
I don’t want you to get on the phone and just say
“help, we need help over here,’’ and hang up, and
that’s happened to me as a nurse, you know. So in
the first aid, this has really helped in the
community. People will start to tell me who they
are and where thev are and I say that’s what I need
to know first. I don’t care who it is that’s down,
what’s happened to them, but I need to know where
you are so that I can come there__________________

Skills not
always
applied,
even
though
other
people
have them,
especially if
instructor
present in
a situation.
However,
there is
some
application
by other
people in
this
workplace
setting, as
well.

Also
practical
skills for
instructors,
that they
can apply
when
needed.

Appropriate
dealing
w ith

emergency
and
appropriate
connection
with health
services.

115

6B

Apply in
relation to
work

Opportun
ity to
blossom

2A

Employa
bility,
requirem
ent for
work

1A

2B

2A
9B

Leading
to career
options,
choice in
educatio
n and in

1D

And the thing is is that they inevitably run into a
situation where they actually have to help
somebody. And that usually happens within the
first couple of weeks of being on the mountain.
And the first thing that happens inevitably is that
they go brain dead. And it’s, OK, what do I have to
do? What do I have to do? And they come in and
they fumble their way through it and the guy
survives and thanks them profusely for getting him
off the mountain. They looked after. But then they
go through and do their own mental debriefing. I
forgot to identify myself. I forgot to do this. I
forgot to do that. But the thing is that they’ve got
into it and they’ve taken the first move.
how would I describe a student who comes to the
College? I look at them as a closed bud, a flower
bud. And as they are learning and as they are
feeling better about themselves, the bud just opens
right up.
And I think the thing is that one thing leads on to
the other, so the bud sort of opens up and they
basically open to more sunshine, they feel better
about themselves, and that hopefully goes towards
the family and it helps out there, too. Because
these people aren’t so angry any more.
And they have their employable skills. They can
take it here in their own home and then go off and
work in northern B.C. on an oil rig or something.

Put in
capacity
building
section

Well, I just did a re-cert the other night and we had
8 people here and every one of them, none of them,
no, one person was First Nations, the rest were not,
but every one of them basically said it was a
requirement for work.
(leads to) Getting employment actually
Whether it’s because it’s a job requirement, the
outcome is very obvious there that if I don’t
recertify, then what’s going to happen to my job?
They know this is a requirement and I wanna get a
job and if I have this, this enhances my
opportunities in terms of getting a job.
But even volunteers, you know, I know people who
start off as volunteer firefighters and that. They’re
now, that’s their career.

116

life

2A

5A

And many a time, we’ll have people come into the
College, sign up for a first aid course or whatever,
and the next thing you know they’re looking at the
ad and say, oh, this looks interesting, maybe I
should do this, or do you think I could do this or
whatever. The next thing you know, you’ve got
students taking short courses, and then maybe
they’re coming in to academic courses. It varies.
And we’ve had more people go on from there. We
had one teenager who was kicked out of school,
he’ll never do anything, dadada. They put him in
the YES program, Yukon Employment Strategy
program and one of the first weeks he was to do
this first aid course, and he was the best student I
have ever had. He couldn’t’ read but somebody
had read the book to him, he had learned to do this
stuff and he did better bandaging than I did. And
he was so proud. He is now a carpenter in town.
And he’s great. Goes to work. If he has to ride his
bike, he’s there on time, whatever. But this was the
first certificate he’d got, he told me. It was the first
thing I’ve ever done and finished, so that incredible
sense of accomplishment that comes from doing
that first aid course and getting through it. So
that’s why I really work hard with people who I
know are struggling. And like. I’ve been there long
enough, I know some of there issues and their
schooling and their lack of education or whatever
you want to call it._____________________________

Incredibly
powerful
impact of
first aid
accomplish
ment in
affecting
person's
life.

117