Volunteers are recognized as an important human resource for health promotion efforts not only in low- and middle-income countries, but increasingly, in high-income countries such as Canada. Indeed, volunteers have been shown to be effective in supporting behavior modification to help prevent chronic disease among older adults (1), assist in smoking cessation, or improve management of hypertension and diabetes (2). Frequently, they serve as a bridge between the formal health care system, the patient, and community programs and resources (3,4). Volunteers can play a key role in strengthening health systems to provide person-centered care that is equitable, culturally appropriate and economically feasible (5).
Older volunteers, in particular, bring a wealth of experience that benefits their communities but also themselves. Volunteering, particularly by the elderly, may contribute to physical, social, and cognitive health and well-being (6-10), as well as to an increased quality of life, sense of self-worth and longevity (10,11). The increased social networks, resources, power and prestige, and emotional fulfillment that can be gained through volunteering have been documented as some of the additional benefits (12).
Volunteers who are also members of the target population are well-positioned to overcome social, linguistic and cultural barriers to effectively increase public awareness of health issues. Social cognitive theory suggests that peers are influential because individuals are more likely to imitate a behavior exhibited by someone who is a realistic model (13). Age-matched peers are particularly effective in programs targeting older adults, perhaps due to enhanced communication and rapport from shared life experiences as a birth cohort (14-16).
Volunteering in Canada is a deeply rooted tradition tracing back to the European settlers and immigrants from around the world. As a country of immigrants, faced with the wilderness and harsh winters, there has always been a strong emphasis on self-reliance but also on mutual assistance.
In the province of Quebec in Canada, the culture of volunteering appears to be different from the rest of the country. The 2004, 2007, 2010 and 2013 Canada Survey of Giving, Volunteering and Participating (CSGVP) reported that Quebec is the Canadian province with the least amount of volunteering (17). In 2013, 32% of people aged 15 and older volunteered in Quebec, the lowest rate in the country, compared to the Canadian average of 44% (17). Furthermore, the average yearly number of hours volunteered in Quebec in 2013 was 123 hours, the lowest in Canada, compared to a national average of 154 hours (median of 39 and 53 hours, respectively) (17). An analysis of 2012 Statistics Canada data by the Institut de la Statistique du Québec revealed differences in volunteer participation between French-speaking and English-speaking Quebecers (18). The study reported that Quebecers whose language spoken at home is English are more likely to volunteer (47%) than those whose spoken language at home is French (36%) (18).
There are several hypotheses as to why the rate of volunteering is different. One plausible explanation has to do with how volunteering is defined by different surveys or how it is interpreted by the respondents themselves. It has been suggested, for example, that the French-speaking Canadians are more likely to be involved in more informal volunteer activities focused on friends or neighbors and thus not captured in more formal, organization-based volunteering activities as those reported in the CSGVP.
Our team has been involved in developing, refining and implementing CHAP for the past 20 years in English Canada (Ontario and Alberta) and as such CHAP represents the main experience that we have working with volunteers. The focus of the current study was specifically on volunteers who participated in CHAP against the backdrop of broader differences reported by different surveys between English- and French-speaking volunteers in Canada and in Quebec.
The Cardiovascular Health Awareness Program (CHAP: www.CHAPprogram.ca) is a community-based cardiovascular diseases (CVD) prevention and management program that has been implemented across Canada over the past 20 years. It was first implemented in several English-speaking settings in Canada, predominately in the province of Ontario, and subsequently modified and adapted to several different settings and populations, including the French-speaking province of Quebec.
CHAP recruits, trains, and deploys volunteers to assist members of their communities to increase awareness around CVD, monitor their blood pressure and adopt or maintain a healthy lifestyle. Volunteers are a vital component of CHAP as the program relies on locally recruited peer volunteers to: 1) assist program participants with accurate measurement of participants’ blood pressure and other physical measures (waist circumference, weight, height and body mass index (BMI)), completing a cardiovascular risk profile, including a questionnaire-based evaluation of risk of developing type 2 diabetes (CANRISK), 2) provide participants with educational messages about lifestyle modifications, and 3) loop back with primary care providers and recommend locally available free or low cost programs and resources.
The CHAP model was refined through a series of studies that demonstrated its implementability, acceptability and ability to reduce participants’ BP, encourage lifestyle changes and optimize drug regimens (19-25). CHAP was rigorously evaluated using a community cluster randomized controlled trial involving 39 medium-sized communities (with populations of 10,000-60,000) in Ontario. Over 13,000 people aged over 65 years in the CHAP communities attended cardiovascular risk assessment and education sessions run by 600 volunteers in community-based pharmacies over a 10-week period. Adjusting for hospital admission rates in the year prior to the intervention, after one year, CHAP was associated with a 9% reduction in hospital admissions at the population level for stroke, acute myocardial infarction and congestive heart failure among residents aged ≥ 65 years (p=0.002) relative to communities that did not implement CHAP (26). CHAP is the main evidence supporting more intense screening for hypertension, recommended by the Canadian Task Force on Preventive Health Care (CTFPHC) (27) and the U.S. Preventive Services Task Force (USPSTF) (28). We estimate that over 100,000 CHAP assessments have been conducted since its inception.
In light of the possible differences regarding culture of volunteering in Quebec, the objective of the current study was to learn more about French speaking Québec volunteers’ motivation, satisfaction and perceived benefits of volunteering. We also wanted to generate a profile of Quebecers volunteering for CHAP and to compare it with English-speaking volunteers in Ontario who participated in an earlier pharmacy-based CHAP program (19), with volunteers in Canada and in Quebec as reported in Statistics Canada's General Social Survey on Giving, Volunteering and Participating (CSGVP) (17,18), and with the volunteer survey in Quebec conducted by the Réseau de l'Action Bénévole du Québec (RABQ) (29).