One program, three modalities of implementation: Analyzing the adaptability of a professional development program in health promotion Marie-Claude Tremblay,

One program, three modalities of implementation: Analyzing the adaptability of a professional

development program in health promotion

Marie-Claude Tremblay, PhD Lucie Richard, Sara Torres, Nicole Beaudet, Eric

Litvak, François Chiocchio, Julie Des Lauriers

Professional development = a key component of an effective public health infrastructure.

Professional development programs need to be adapted to different and complex real-world practice settings while preserving the core components of the model being used.

This is articulating the interplay between fidelity and adaptability to a specific context.

Context

This communication aims to present how a public health professional development program, the Health Promotion Laboratory,

has been adapted in three different practice settings while preserving its core

nature.

Objectives

In 2009, a team from the public health directorate for Montreal (PHDM, Québec) launched an innovative professional development program, the Health Promotion Laboratory.

This intervention aims to support, innovatively and flexibly, multidisciplinary local health centre (CSSS) teams working on particular issues (themes), so that they can design and implement a specific health promotion intervention.

Intervention: the Health Promotion Laboratory

Each HPL is based on a target issue or theme, which is chosen by the participating CSSS.

Each team = approximately ten voluntarily participants.

HPL = Lenghty process involving three-hour meetings every two or three weeks (for two or three years).

Meetings are led by one participant, supported by a mentor from the program promoter agency (PHDM).


Steps (core program components)

1) Identify a targeted theme and a team

2) Specify the operational approach

3a)* Acquire basic concepts of public health and provide opportunities for reflection3b)* Transfer new knowledge and ensure sustainability of the program

4) Study the problem (theme)

5) Identify options for action

6) Develop partnerships

7) Implement a new health promotion action or improve a current intervention


The steps of the operational approach = the program’s core components (which refer to the program’s theory).

How core components are implemented (format and number of activities, sequence of implementation) = the adaptive part of the program.


This implementation analysis is part of a larger multiple case study evaluating the implementation, processes, and outcomes of the Health Promotion Laboratory (Richard et

al., 2014).

This study involves three sites (A, B and C) and uses documentary sources of data.

Methods

Teams Theme of the HPL

Project developed

Lab A Occupational health

A health promotion counseling program to support business owners who were either setting up or relocating their operations in the CSSS’s territory.

Lab B Student retention

A health promotion outreach strategy to work with schools to promote the value of education among parents of elementary school children.

Lab C Children experiencing vulnerability

Four little intervention projects acting on different factors related to protecting vulnerable children in their territory

The cases

Data analysis

Grille de classification - Implantation des laboratoires

No de séance Séance 1 Travail extérieur Séance 2 Travail extérieur Séance 3 Travail extérieur Séance 4 Travail extérieur Séance 5 Travail extérieur Date de la séance 20 jan. 2010 3 fév. 2010 17 fév. 2010 03 mar. 2010 17 mar. 2010

Activités

Présentation aux participants : Historique du projet, attentes et intéressement

Discussion et retour sur la description du projet

Lecture : L’approche populationnelle au quotidien

Discussion sur un article traitant de l'approche populationnelle

Lecture : le partenariat, comment ça marche?

Discussion de l'article sur le partenariat

Lecture : La santé autrement dit. (déterminants de la santé)

Discussion sur l'article concernant les déterminants de la santé

Rencontre d'équipe SST - présentation des concepts de prévention et promotion

Présentation et description du projet de laboratoire (modèle et théorie)

Exercice de classification des activités professionnelles selon promotion/prévention

Discussion sur les incitatifs et les contraintes à la participation au laboratoire (avec grille I)

Rencontre d'équipe SST - présentation du laboratoire

Retour et discussion sur l'accueil du projet par l'équipe élargie de SST

Préparation de la prochaine réunion avec l'équipe élargie de SST (point de repères prévention et promotion)

Présentation du thème de départ (projet spécifique en SST)

Retour et discussion sur l'approche populationnelle

Discussion et échanges sur les rôles respectifs par instance

Discussion pour définition le rôle de l’équipe élargie (SST) dans le projet

Suite de la discussion sur l'enjeu, enrichie des commentaires de l'équipe SST

Discussion sur l'approche populationnelle

Discussion sur les pratiques concernant les lectures

Préparation d'une présentation à l'équipe élargie de SST

Présentation et discussion sur la démarche opérationnelle proposée

Évaluation sous forme d'appréciation de la performance'

Évaluation informelle de la rencontre

Présentation de l'évaluation avec MC

Évaluation de la rencontre (MC)

Début du travail sur l'enjeu (Discussion autour du choix de l'enjeu)

Findings highlight that, owing to their particular contexts, all sites developed a

unique and adapted approach to implement differently the core components of the

program.

Results

Step targeted Team A

N (%)

Team B

N (%)

Team C

N (%)1) Identify a targeted issue and a team

4 (2.4%) 2 (1.4%) 3 (1.1%)

2) Specify the operational approach

11 (6.6%) 12 (8.6%) 11 (4.2%)

3a) Acquire basic concepts of public health and provide opportunities for reflection

7 (4.2%) 4 (2.9%) 10 (3.8%)

3b) Transfer new knowledge and ensure sustainability of the program

69 (41.6%) 33 (23.6%) 83 (31.8)%

4) Study the problem (theme or targeted issue)

28 (16.9%) 29 (20.7%) 28 (10.7%)

5) Identify options for action

5 (3.0%) 28 (20.0%) 42 (16.1%)

6) Develop partnerships 17 (10.2%) 19 (13.6%) 37 (14.2%)

7) Implement a new health promotion action or improve a current intervention

25 (15.1%)

13 (9.3%) 47 (18.0%)

Total

166 (100%)

(spanning29 meetings)

140 (100%)


261 (100%)


Table 1. Percentage of activities devoted to each step

Figure 1. Pattern of implementation - Lab A

0

10

20

30

40

50

60

70

80

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30

Séances

No

mb

re d'a

cti

vit

és

1. Identifier un enjeu et une équipe 2. Préciser la démarche opérationnelle

3. a) S’approprier les concepts de base en santé publique 3. b) Transfert des connaissances et pérennité du programme

4. Approfondir l’enjeu 5. Identifier des possibilités d’action

6. Développer un partenariat 7. Implanter une nouvelle action en promotion de la santé

Figure 2. Pattern of implementation - Lab B

0

5

10

15

20

25

30

35

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40

Séances

No

mb

re d'a

cti

vit

és





Figure 3. Pattern of implementation – Lab C

0

10

20

30

40

50

60

70

80

90

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56

Séances

No

mb

re d'

ac

tiv

ité

s





The findings presented here show that a health promotion professional development program can be successfully tailored to different settings without compromising its core components.

HPL Program allows for : (1) an initial pre-formatting to accommodate

organizational context (theme chosen, team composition, HPL formula);

(2) an ongoing adaptation of implementation to take into account the needs of the participants (nature and number of the activities, patterns of implementation in time)

Discussion

This work highlights the need to make explicit the core elements of a program theory that are

critical to achieving the program’s intended outcomes.

It also illustrates the importance of providing flexibility in a program’s design, such that it can be adapted beforehand to different contexts and then on the ground as the implementation

unfolds.

Conclusion

For more information on this project, please contact

Marie-Claude Tremblay: [email protected](research associate)Lucie Richard : [email protected](ALPS principal investigator)Nicole Beaudet : [email protected](project manager)

Thank you!

mailto:[email protected]



Documents

One program, three modalities of implementation: Analyzing the adaptability of a professional development program in health promotion Marie-Claude Tremblay,