1
|
Ndjaboue R, Beaudoin C, Comeau S, Dagnault A, Dogba MJ, Numainville S, Racine C, Straus S, Tremblay MC, Witteman HO. Patients as teachers: a within-subjects randomized pilot experiment of patient-led online learning modules for health professionals. BMC Med Educ 2024; 24:525. [PMID: 38730313 DOI: 10.1186/s12909-024-05473-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/25/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE Many health professions education programs involve people with lived experience as expert speakers. Such presentations may help learners better understand the realities of living with chronic illness or experiencing an acute health problem. However, lectures from only one or a small number of people may not adequately illustrate the perspectives and experiences of a diverse patient cohort. Additionally, logistical constraints such as public health restrictions or travel barriers may impede in-person presentations, particularly among people who have more restrictions on their time. Health professions education programs may benefit from understanding the potential effects of online patient-led presentations with a diverse set of speakers. We aimed to explore whether patient-led online learning modules about diabetes care would influence learners' responses to clinical scenarios and to collect learners' feedback about the modules. METHOD This within-subjects randomized experiment involved 26 third-year medical students at Université Laval in Quebec, Canada. Participation in the experiment was an optional component within a required course. Prior to the intervention, participating learners responded to three clinical scenarios randomly selected from a set of six such scenarios. Each participant responded to the other three scenarios after the intervention. The intervention consisted of patient-led online learning modules incorporating segments of narratives from 21 patient partners (11 racialized or Indigenous) describing why and how clinicians could provide patient-centered care. Working with clinical teachers and psychometric experts, we developed a scoring grid based on the biopsychosocial model and set 0.6 as a passing score. Independent evaluators, blinded to whether each response was collected before or after the intervention, then scored learners' responses to scenarios using the grid. We used Fisher's Exact test to compare proportions of passing scores before and after the intervention. RESULTS Learners' overall percentage of passing scores prior to the intervention was 66%. Following the intervention, the percentage of passing scores was 76% (p = 0.002). Overall, learners expressed appreciation and other positive feedback regarding the patient-led online learning modules. DISCUSSION Findings from this experiment suggest that learners can learn to provide better patient-centered care by watching patient-led online learning modules created in collaboration with a diversity of patient partners.
Collapse
|
2
|
Massé J, Grignon S, Vigneault L, Olivier-D'Avignon G, Tremblay MC. Patients' perspectives on their motivations for participating in non-clinical medical teaching and what they gain from their experience: a qualitative study informed by critical theory. Adv Health Sci Educ Theory Pract 2024; 29:217-243. [PMID: 37382856 DOI: 10.1007/s10459-023-10262-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/18/2023] [Indexed: 06/30/2023]
Abstract
In 2019-2021, we engaged in a project aimed at developing, implementing, and evaluating an educational intervention actively involving patient-teachers in undergraduate medical education at Université Laval, Quebec, Canada. Patient-teachers were invited to participate in small group discussion workshops during which medical students deliberate on legal, ethical, and moral issues arising from medical practice. Patients were expected to bring other perspectives, based on their experience with illness and the healthcare system. Little is still known about patients' perspectives on their participation experience in such context. Informed by critical theory, our qualitative study aims to document,: (i) the motivating factors for patients' participation in our intervention; and (ii) what patients gained from the experience. Data collection was based on 10 semi-structured interviews with patient-teachers. A thematic analysis was conducted using NVivo software. Motivators for participation arose from: (i) perceived consistency between patients' individual characteristics and those of the project, and (ii) conceiving the project as a means to reach individual and social goals. What patients gained mainly refers to (1) the appreciation of a positive, enriching, motivating yet uncomfortable and destabilizing experience; (2) a deconstruction of biases against the medical field and critical thinking about their own experience; (3) new knowledge, with a potential impact on their future interactions with the healthcare system. Results reveal patients as non-neutral thinking and knowing subjects, engaged in the participation experience as active teachers and learners. They also highlight the empowering and emancipatory nature of the learning gained through patients' participation experience. These conclusions prompt us to promote transformative interventional approaches that question the pervasive power issues in medical teaching and value patients' specific knowledge in teaching and learning the Art of Medicine.
Collapse
Affiliation(s)
- Julie Massé
- Faculty of medicine, Université Laval, 1050 avenue de la Médecine, Quebec City, Québec, Canada.
- Faculty of nursing, Université Laval, 1050 avenue de la Médecine, Quebec City, Québec, Canada.
- Vitam, Centre de recherche en santé durable, 2480 chemin de la Canardière, Quebec City, Québec, Canada.
| | - Sophie Grignon
- Faculty of medicine, Université Laval, 1050 avenue de la Médecine, Quebec City, Québec, Canada
- Patient-Partner, Quebec City, Québec, Canada
| | - Luc Vigneault
- Faculty of medicine, Université Laval, 1050 avenue de la Médecine, Quebec City, Québec, Canada
- Vitam, Centre de recherche en santé durable, 2480 chemin de la Canardière, Quebec City, Québec, Canada
- Patient-Partner, Quebec City, Québec, Canada
| | | | - Marie-Claude Tremblay
- Faculty of medicine, Université Laval, 1050 avenue de la Médecine, Quebec City, Québec, Canada
- Vitam, Centre de recherche en santé durable, 2480 chemin de la Canardière, Quebec City, Québec, Canada
| |
Collapse
|
3
|
Blanchette V, Todkar S, Brousseau-Foley M, Rheault N, Weisz T, Poitras ME, Paquette JS, Tremblay MC, Costa IG, Dogba MJ, Giguere A, de Mestral C, Légaré F. Collaboration and Partnership in a 5-Level Engagement Framework for Diabetic Foot Ulcer Management: A Patient-oriented Scoping Review. Can J Diabetes 2023; 47:682-694.e17. [PMID: 37437841 DOI: 10.1016/j.jcjd.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE The management of diabetic foot ulcers (DFUs) is complex, and patient engagement is essential for DFU healing, but it often comes down to the patient's consultation. Therefore, we sought to document patients' engagement in terms of collaboration and partnership for DFUs in 5 levels (direct care, organizational, policy level, research, and education), as well as strategies for patient engagement using an adapted engagement framework. METHODS We conducted a scoping review of the literature from inception to April 2022 using the Joanna Briggs Institute method and a patient-oriented approach. We also consulted DFU stakeholders to obtain feedback on the findings. The data were extracted using PROGRESS+ factors for an equity lens. The effects of engagement were described using Bodenheimer's quadruple aims for value-based care. RESULTS Of 4,211 potentially eligible records, 15 studies met our eligibility criteria, including 214 patients involved in engagement initiatives. Most studies were recent (9 of 15 since 2020) and involved patient engagement at the direct medical care level (8 of 15). Self-management (7 of 15) was the principal way to clinically engage the patients. None of the studies sought to define the direct influence of patient engagement on health outcomes. CONCLUSIONS Very few studies described patients' characteristics. Engaged patients were typically men from high-income countries, in their 50s, with poorly managed type 2 diabetes. We found little rigorous research of patient engagement at all levels for DFUs. There is an urgent need to improve the reporting of research in this area and to engage a diversity of patients.
Collapse
Affiliation(s)
- Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada.
| | - Shweta Todkar
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Magali Brousseau-Foley
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec, affiliated with Family Medicine and Emergency Medicine Department, Faculty of Medicine, Université de Montréal, Trois-Rivières, Canada
| | - Nathalie Rheault
- Québec SSA Support Unit, Sherbrooke University, Longueil Campus, Longueuil, Québec, Canada
| | - Tom Weisz
- Patient Partner, Diabetes Action Canada, Toronto General Hospital, Toronto, Ontario, Canada; Patient Partner, Wounds Canada, North York, Ontario, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Sherbrooke University, Saguenay, Québec, Canada
| | - Jean-Sébastien Paquette
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada
| | - Marie-Claude Tremblay
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada
| | - Idevânia G Costa
- School of Nursing, Lakehead University, Thunder Bay, Ontario, Canada
| | - Maman Joyce Dogba
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada
| | - Anik Giguere
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Vascular Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; VITAM---Centre de recherche en santé durable, Research Centre, Québec, Canada; Canada Research Chair in Shared Decision-Making and Knowledge Translation, Québec, Canada
| |
Collapse
|
4
|
Wang YP, Bernatchez F, Chouinard-Castonguay S, Tremblay MC, Vanasse A, Kinnard N, Mégalli M, Millette M, Boulet G, Henderson M, Simoneau-Roy J, Brazeau AS, Rabasa-Lhoret R, Gagnon C. Comparison of Intranasal and Injectable Glucagon Administration Among Pediatric Population Responders. Diabetes Technol Ther 2023; 25:808-816. [PMID: 37751153 DOI: 10.1089/dia.2023.0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Aims: Ease of use and acceptability of nasal versus injectable glucagon (IG) among pediatric responders have been little investigated. This study compared the performance of administering nasal and IG in parents of youth with type 1 diabetes (T1D) and in school workers. Enablers and barriers associated with each glucagon and preferred glucagon administration learning modality were also evaluated. Methods: Three months after watching short pedagogical videos, 30 parents and 30 school workers performed simulated scenarios where they administered both glucagon. Completion time and successful execution of critical steps were collected. Interviews assessed preferred learning modalities, barriers, and enablers associated with each glucagon. Results: Both groups administered nasal glucagon faster than IG (median [interquartile range]: parents 19 [12-29] vs. 97 [71-117] s, P < 0.001; school workers 24 [16-33] vs. 129 [105-165] s, P < 0.001). A lower proportion of participants successfully executed all critical steps for injectable versus nasal glucagon (significant difference for school workers [53% vs. 90%; P = 0.007] but not for parents [68% vs. 83%; P = 0.227]). Nasal glucagon was preferred for ease of use and acceptability. Preferred learning modalities were a combination of videos and workshops, but videos alone could suffice for nasal glucagon. Conclusions: Nasal glucagon is faster to use, more likely to be successfully administered, and more acceptable than IG for parents of children with T1D and school workers. Nasal glucagon training with videos could improve school workers' involvement in severe hypoglycemia management. Clinical Trial number, URL to the registration: NCT05395000, https://clinicaltrials.gov/ct2/show/NCT05395000.
Collapse
Affiliation(s)
- Yue-Pei Wang
- CHU de Québec-Université Laval Research Centre, Centre Hospitalier de l'Université Laval, Quebec, Canada
| | - Francesca Bernatchez
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Sarah Chouinard-Castonguay
- CHU de Québec-Université Laval Research Centre, Centre Hospitalier de l'Université Laval, Quebec, Canada
| | - Marie-Claude Tremblay
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
- VITAM, Sustainable Health Research Centre, Quebec, Canada
| | - Andréane Vanasse
- Patient Partners of the BETTER Registry for Type 1 Diabetes, Quebec, Canada
| | - Nathalie Kinnard
- Patient Partners of the BETTER Registry for Type 1 Diabetes, Quebec, Canada
| | - Mélissa Mégalli
- CHU de Québec-Université Laval Research Centre, Centre Hospitalier de l'Université Laval, Quebec, Canada
| | - Maude Millette
- Department of Pediatrics, Université Laval, Quebec, Canada
| | | | - Mélanie Henderson
- Department of Pediatrics, Université de Montréal, Montreal, Canada
- CHU Ste-Justine Research Center, Montreal, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada
| | - Judith Simoneau-Roy
- Department of Pediatrics, Endocrinology Division, Faculty of Medicine and Health Sciences, CIUSSS-Estrie CHUS, Université de Sherbooke, Sherbrooke, Canada
| | | | - Rémi Rabasa-Lhoret
- Faculty and Department of Medicine, Clinical Research Institute of Montreal, Université de Montréal, Montreal, Canada
| | - Claudia Gagnon
- CHU de Québec-Université Laval Research Centre, Centre Hospitalier de l'Université Laval, Quebec, Canada
- Department of Medicine, Université Laval, Quebec, Canada
| |
Collapse
|
5
|
Massé J, Beaura S, Tremblay MC. Fostering the development of non-technical competencies in medical learners through patient engagement: a rapid review. Can Med Educ J 2023; 14:47-69. [PMID: 37719397 PMCID: PMC10500390 DOI: 10.36834/cmej.73630] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background To train physicians who will respond to patients' evolving needs and expectations, medical schools must seek educational strategies to foster the development of non-technical competencies in students. This article aims to synthetize studies that focus on patient engagement in medical training as a promising strategy to foster the development of those competencies. Methods We conducted a rapid review of the literature to synthetize primary quantitative, qualitative and mixed studies (January 2000-January 2022) describing patient engagement interventions in medical education and reporting non-technical learning outcomes. Studies were extracted from Medline and ERIC. Two independent reviewers were involved in study selection and data extraction. A narrative synthesis of results was performed. Results Of the 3875 identified, 24 met the inclusion criteria and were retained. We found evidence of a range of non-technical educational outcomes (e. g. attitudinal changes, new knowledge and understanding). Studies also described various approaches regarding patient recruitment, preparation, and support and participation design (e.g., contact duration, learning environment, patient autonomy, and format). Some emerging practical suggestions are proposed. Conclusion Our results suggest that patient engagement in medical education can be a valuable means to foster a range of non-technical competencies, as well as formative and critical reflexivity. They also suggest conditions under which patient engagement practices can be more efficient in fostering non-instrumental patient roles in different educational contexts. This supports a plea for sensible and responsive interventional approaches.
Collapse
Affiliation(s)
- Julie Massé
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
- VITAM, Centre de recherche en santé durable, Quebec, Canada
- Faculty of nursing, Université Laval, Quebec, Canada
| | - Stéphanie Beaura
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Marie-Claude Tremblay
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
- VITAM, Centre de recherche en santé durable, Quebec, Canada
| |
Collapse
|
6
|
Blanchette V, Patry J, Brousseau-Foley M, Todkar S, Libier S, Leclerc AM, Armstrong DG, Tremblay MC. Diabetic foot complications among Indigenous peoples in Canada: a scoping review through the PROGRESS-PLUS equity lens. Front Endocrinol (Lausanne) 2023; 14:1177020. [PMID: 37645408 PMCID: PMC10461566 DOI: 10.3389/fendo.2023.1177020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Indigenous peoples in Canada face a disproportionate burden of diabetes-related foot complications (DRFC), such as foot ulcers, lower extremity amputations (LEA), and peripheral arterial disease. This scoping review aimed to provide a comprehensive understanding of DRFC among First Nations, Métis, and Inuit peoples in Canada, incorporating an equity lens. Methods A scoping review was conducted based on Arksey and O'Malley refined by the Joanna Briggs Institute. The PROGRESS-Plus framework was utilized to extract data and incorporate an equity lens. A critical appraisal was performed, and Indigenous stakeholders were consulted for feedback. We identified the incorporation of patient-oriented/centered research (POR). Results Of 5,323 records identified, 40 studies were included in the review. The majority of studies focused on First Nations (92%), while representation of the Inuit population was very limited populations (< 3% of studies). LEA was the most studied outcome (76%). Age, gender, ethnicity, and place of residence were the most commonly included variables. Patient-oriented/centered research was mainly included in recent studies (16%). The overall quality of the studies was average. Data synthesis showed a high burden of DRFC among Indigenous populations compared to non-Indigenous populations. Indigenous identity and rural/remote communities were associated with the worse outcomes, particularly major LEA. Discussion This study provides a comprehensive understanding of DRFC in Indigenous peoples in Canada of published studies in database. It not only incorporates an equity lens and patient-oriented/centered research but also demonstrates that we need to change our approach. More data is needed to fully understand the burden of DRFC among Indigenous peoples, particularly in the Northern region in Canada where no data are previously available. Western research methods are insufficient to understand the unique situation of Indigenous peoples and it is essential to promote culturally safe and quality healthcare. Conclusion Efforts have been made to manage DRFC, but continued attention and support are necessary to address this population's needs and ensure equitable prevention, access and care that embraces their ways of knowing, being and acting. Systematic review registration Open Science Framework https://osf.io/j9pu7, identifier j9pu7.
Collapse
Affiliation(s)
- Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- VITAM-Centre de Recherche en Santé Durable, Québec, QC, Canada
- Centre de Recherche du Centre Intégré de Santé et Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Jérôme Patry
- Centre de Recherche du Centre Intégré de Santé et Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Medicine, Family and Emergency Medicine Department, Université Laval, Québec, QC, Canada
| | - Magali Brousseau-Foley
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Faculty of Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie et du Centre-du-Québec Affiliated with Université de Montréal, Trois-Rivières Family Medicine University Clinic, Trois-Rivières, QC, Canada
| | - Shweta Todkar
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Solène Libier
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Anne-Marie Leclerc
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Marie-Claude Tremblay
- VITAM-Centre de Recherche en Santé Durable, Québec, QC, Canada
- Faculty of Medicine, Family and Emergency Medicine Department, Université Laval, Québec, QC, Canada
| |
Collapse
|
7
|
Diouf NT, Musabyimana A, Blanchette V, Lépine J, Guay-Bélanger S, Tremblay MC, Dogba MJ, Légaré F. Effectiveness of Shared Decision-making Training Programs for Health Care Professionals Using Reflexivity Strategies: Secondary Analysis of a Systematic Review. JMIR Med Educ 2022; 8:e42033. [PMID: 36318726 PMCID: PMC9773026 DOI: 10.2196/42033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/05/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Shared decision-making (SDM) leads to better health care processes through collaboration between health care professionals and patients. Training is recognized as a promising intervention to foster SDM by health care professionals. However, the most effective training type is still unclear. Reflexivity is an exercise that leads health care professionals to question their own values to better consider patient values and support patients while least influencing their decisions. Training that uses reflexivity strategies could motivate them to engage in SDM and be more open to diversity. OBJECTIVE In this secondary analysis of a 2018 Cochrane review of interventions for improving SDM by health care professionals, we aimed to identify SDM training programs that included reflexivity strategies and were assessed as effective. In addition, we aimed to explore whether further factors can be associated with or enhance their effectiveness. METHODS From the Cochrane review, we first extracted training programs targeting health care professionals. Second, we developed a grid to help identify training programs that used reflexivity strategies. Third, those identified were further categorized according to the type of strategy used. At each step, we identified the proportion of programs that were classified as effective by the Cochrane review (2018) so that we could compare their effectiveness. In addition, we wanted to see whether effectiveness was similar between programs using peer-to-peer group learning and those with an interprofessional orientation. Finally, the Cochrane review selected programs that were evaluated using patient-reported or observer-reported outcome measurements. We examined which of these measurements was most often used in effective training programs. RESULTS Of the 31 training programs extracted, 24 (77%) were interactive, among which 10 (42%) were considered effective. Of these 31 programs, 7 (23%) were unidirectional, among which 1 (14%) was considered effective. Of the 24 interactive programs, 7 (29%) included reflexivity strategies. Of the 7 training programs with reflexivity strategies, 5 (71%) used a peer-to-peer group learning strategy, among which 3 (60%) were effective; the other 2 (29%) used a self-appraisal individual learning strategy, neither of which was effective. Of the 31 training programs extracted, 5 (16%) programs had an interprofessional orientation, among which 3 (60%) were effective; the remaining 26 (84%) of the 31 programs were without interprofessional orientation, among which 8 (31%) were effective. Finally, 12 (39%) of 31 programs used observer-based measurements, among which more than half (7/12, 58%) were effective. CONCLUSIONS Our study is the first to evaluate the effectiveness of SDM training programs that include reflexivity strategies. Its conclusions open avenues for enriching future SDM training programs with reflexivity strategies. The grid developed to identify training programs that used reflexivity strategies, when further tested and validated, can guide future assessments of reflexivity components in SDM training.
Collapse
Affiliation(s)
- Ndeye Thiab Diouf
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Community Health, Faculty of Nursing and Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Angèle Musabyimana
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Community Health, Faculty of Nursing and Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Virginie Blanchette
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Human Kinetic and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Johanie Lépine
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Sabrina Guay-Bélanger
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Marie-Claude Tremblay
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Office of Education and Continuing Professional Education, Université Laval, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Maman Joyce Dogba
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Office of Education and Continuing Professional Education, Université Laval, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| |
Collapse
|
8
|
Tremblay MC. Strengthening the gendered health promotion agenda. Health Promot Int 2022; 37:6680027. [PMID: 36047635 DOI: 10.1093/heapro/daac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marie-Claude Tremblay
- Department of Family Medicine and Emergency Medicine, Université Laval, 1050, de la médecine, 2881-F, Quebec, QC G1V 0A6, Canada
| |
Collapse
|
9
|
Durand F, Richard L, Beaudet N, Fortin-Pellerin L, Hudon AM, Tremblay MC. Healthcare professionals' longitudinal perceptions of group phenomena as determinants of self-assessed learning in organizational communities of practice. BMC Med Educ 2022; 22:75. [PMID: 35114973 PMCID: PMC8815148 DOI: 10.1186/s12909-022-03137-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Given the importance of continuous learning as a response to the increasing complexity of health care practice, there is a need to better understand what makes communities of practice in health effective at fostering learning. Despite the conceptual stance that communities of practice facilitate individual learning, the scientific literature does not offer much evidence for this. Known factors associated with the effectiveness of communities of practice - such as collaboration, psychological safety within the community, and commitment to the community - have been studied in cross-sectional qualitative designs. However, no studies to date have used a quantitative predictive design. The objective of this study is to assess how members of a community of practice perceive interactions among themselves and determine the extent to which these interactions predict self-assessed learning over time. METHODS Data was collected using validated questionnaires from six communities of practice (N = 83) in four waves of measures over the course of 36 months and was analysed by means of General Estimating Equations. This allowed to build a longitudinal model of the associations between perceptions of collaboration, psychological safety within the community, commitment to the community and self-assessed learning over time. RESULTS Perception of collaboration in the community of practice, a personal sense of psychological safety and a commitment to the community of practice are predictors longitudinally associated with self-assessed learning. CONCLUSIONS In terms of theory, conceptual links can be made between intensity of collaboration and learning over time in the context of a community of practice. Recent work on psychological safety suggests that it is still unclear whether psychological safety acts as a direct enhancer of learning or as a remover of barriers to learning. This study's longitudinal results suggest that psychological safety may enhance how and to what extent professionals feel they learn over time. Commitment towards the community of practice is a strong predictor of learning over time, which hints at differential effects of affective, normative and continuance commitment. Communities of practice can therefore apply these findings by making collaboration, psychological safety, commitment and learning regular reflexive topics of discussion.
Collapse
Affiliation(s)
- François Durand
- Montfort Research Chair in Organization of Health Services, Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, Ontario K1N 6N5 Canada
| | - Lucie Richard
- Faculté des sciences infirmières, Université de Montréal, Montréal, Canada
| | - Nicole Beaudet
- Direction de santé publique de Montréal, Montréal, Canada
| | | | | | - Marie-Claude Tremblay
- Département de médecine de famille et de médecine d’urgence, Université Laval, Quebec, Canada
| |
Collapse
|
10
|
|
11
|
Spagnolo J, Breton M, Sasseville M, Sauvé C, Clément JF, Fleet R, Tremblay MC, Rodrigue C, Lebel C, Beauséjour M. Exploring the implementation and underlying mechanisms of centralized referral systems to access specialized health services in Quebec. BMC Health Serv Res 2021; 21:1345. [PMID: 34915871 PMCID: PMC8674406 DOI: 10.1186/s12913-021-07286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/09/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND In 2016, Quebec, a Canadian province, implemented a program to improve access to specialized health services (Accès priorisé aux services spécialisés (APSS)), which includes single regional access points for processing requests to such services via primary care (Centre de répartition des demandes de services (CRDS)). Family physicians fill out and submit requests for initial consultations with specialists using a standardized form with predefined prioritization levels according to listed reasons for consultations, which is then sent to the centralized referral system (the CRDS) where consultations with specialists are assigned. We 1) described the APSS-CRDS program in three Quebec regions using logic models; 2) compared similarities and differences in the components and processes of the APSS-CRDS models; and 3) explored contextual factors influencing the models' similarities and differences. METHODS We relied on a qualitative study to develop logic models of the implemented APSS-CRDS program in three regions. Semi-structured interviews with health administrators (n = 9) were conducted. The interviews were analysed using a framework analysis approach according to the APSS-CRDS's components included in the initially designed program, Mitchell and Lewis (2003)'s logic model framework, and Chaudoir and colleagues (2013)'s framework on contextual factors' influence on an innovation's implementation. RESULTS Findings show the APSS-CRDS program's regional variability in the implementation of its components, including its structure (centralized/decentralized), human resources involved in implementation and operation, processes to obtain specialists' availability and assess/relay requests, as well as monitoring methods. Variability may be explained by contextual factors' influence, like ministerial and medical associations' involvement, collaborations, the context's implementation readiness, physician practice characteristics, and the program's adaptability. INTERPRETATION Findings are useful to inform decision-makers on the design of programs like the APSS-CRDS, which aim to improve access to specialists, the essential components for the design of these types of interventions, and how contextual factors may influence program implementation. Variability in program design is important to consider as it may influence anticipated effects, a next step for the research team. Results may also inform stakeholders should they wish to implement similar programs to increase access to specialized health services via primary care.
Collapse
Affiliation(s)
- Jessica Spagnolo
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada.,Centre de recherche Charles-LeMoyne, Université de Sherbrooke - Campus Longueuil, 150, place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada
| | - Mylaine Breton
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada.,Centre de recherche Charles-LeMoyne, Université de Sherbrooke - Campus Longueuil, 150, place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada
| | - Martin Sasseville
- Centre de recherche Charles-LeMoyne, Université de Sherbrooke - Campus Longueuil, 150, place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada
| | - Carine Sauvé
- Centre intégré de santé et de services sociaux (CISSS) de la Montérégie-Centre, 3141 Boulevard Taschereau Bureau 220, Greenfield Park, QC, J4V 2H2, Canada
| | - Jean-François Clément
- Centre de recherche Charles-LeMoyne, Université de Sherbrooke - Campus Longueuil, 150, place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, QC, J1K 2R1, Canada
| | - Richard Fleet
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Québec, QC, G1V 0A6, Canada.,Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Pavillon Landry-Poulin, 2525 chemin de la Canardière, Québec, QC, G1J 0A4, Canada
| | - Marie-Claude Tremblay
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Québec, QC, G1V 0A6, Canada.,Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Pavillon Landry-Poulin, 2525 chemin de la Canardière, Québec, QC, G1J 0A4, Canada
| | - Cloé Rodrigue
- Centre de recherche Charles-LeMoyne, Université de Sherbrooke - Campus Longueuil, 150, place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada.,Centre intégré de santé et de services sociaux (CISSS) de la Montérégie-Centre, 3141 Boulevard Taschereau Bureau 220, Greenfield Park, QC, J4V 2H2, Canada
| | - Camille Lebel
- Department of Surgery, Faculty of Medicine, Université de Montréal, C.P, 6128, succursale Centre-ville, Montréal, QC, H3C 3J7, Canada
| | - Marie Beauséjour
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada. .,Centre de recherche Charles-LeMoyne, Université de Sherbrooke - Campus Longueuil, 150, place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada. .,Department of Surgery, Faculty of Medicine, Université de Montréal, C.P, 6128, succursale Centre-ville, Montréal, QC, H3C 3J7, Canada.
| |
Collapse
|
12
|
Massé J, Poulin G, Côté M, Tremblay MC. Patient Engagement in Medical Education During the COVID-19 Pandemic: A Critical Reflection on an Epistemic Challenge. MedEdPublish (2016) 2021; 10:103. [PMID: 38486589 PMCID: PMC10939513 DOI: 10.15694/mep.2021.000103.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Epistemic injustices are defined as power inequalities in the access, recognition and production of knowledge. Their persistence in medical education, especially to the detriment of patients and their specific knowledge, has been documented by several authors. Patient engagement is a new paradigm that involves fostering meaningful patient collaboration at different levels of the healthcare system. Since it is fundamentally based on the recognition of the value and relevance of patients' experiential knowledge, patient engagement in medical education is generally recognized as a desirable strategy to address epistemic injustices in the field. Patient engagement is challenged in the context of COVID-19 where most Canadian medical schools have had to quickly modify their teaching models, stop in-person classes and redirect most activities online. This article presents a critical reflection on the issues raised by COVID-constrained teaching strategies and their impact on epistemic injustices in medical education. It also suggests strategies to favour epistemic justice in medical education despite the pandemic turmoil and online shift. It therefore adds an epistemic perspective to the reflection on the effects of the pandemic on medical education and training, which has been little discussed so far.
Collapse
Affiliation(s)
| | | | - Marilyne Côté
- Mobilisation régionale agir ensemble contre les préjugés
| | | |
Collapse
|
13
|
Tremblay MC, Garceau L, Thiab Diouf N, Guichard A, Quinty J, Gravel C, Rheault C. Improving Understanding of Reflexivity in Family Medicine: Development of an Educational Tool Based on a Rapid Review. MedEdPublish (2016) 2021; 10:181. [PMID: 38486532 PMCID: PMC10939579 DOI: 10.15694/mep.2021.000181.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Background: In the last decade, reflexivity has emerged as a key concept in family medicine, as evidenced by its increasing integration in competency statements and frameworks in the field. However, the concept of reflexivity is inconsistent and ill-defined in medical education literature, with variable purposes and associated processes, which is an important barrier to learning and implementing reflective practices. This project built on the results of a rapid review to develop an educational tool supporting the learning and teaching of reflexivity in family medicine. Methods: We conducted a rapid review of quantitative, qualitative and mixed studies relating to reflexivity in family medicine between May 2007 to May 2017 in PubMed, Embase, PsychInfo, CINHAL, ERIC and Education Source. Two reviewers independently identified, selected and reviewed studies. Results of the review were used to frame the content of the tool. Results: Our research strategy initially identified 810 studies, from which 65 studies were retained for analysis. The different conceptions of reflexivity encountered in the included studies were analyzed using thematic analysis. Four conceptions of reflexivity (i.e. clinical, professional, relational and social reflexivity), with related definitions, goals and processes were identified in the included studies and were used as a basis to develop the Reflexivi-Tool. Conclusion: There is a need to provide clear guidelines regarding the purpose and process of reflexivity, as well as better equipping mentors so they can better facilitate these kinds of skills. Based on a rapid review, this study has allowed the development of a tool that presents and clarifies four main types of reflexivity for medical practice in a concise and user-friendly way. Tools such as Reflexivi-Tool are crucial to support reflective processes that target different dimensions of professionalism.
Collapse
|
14
|
van Allen Z, Dogba MJ, Brent MH, Bach C, Grimshaw JM, Ivers NM, Wang X, McCleary N, Asad S, Chorghay Z, Hakim H, Sutakovic O, Drescher O, Légaré F, Witteman HO, Zettl M, Squires J, Tremblay MC, Randhawa A, Lopez G, Ben Guiza A, Presseau J. Barriers to and enablers of attendance at diabetic retinopathy screening experienced by immigrants to Canada from multiple cultural and linguistic minority groups. Diabet Med 2021; 38:e14429. [PMID: 33068305 DOI: 10.1111/dme.14429] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/11/2020] [Accepted: 10/14/2020] [Indexed: 12/27/2022]
Abstract
AIM To identify barriers to/enablers of attendance at eye screening among three groups of immigrantsto Canada from cultural/linguistic minority groups living with diabetes. METHODS Using a patient-oriented research approach leveraging Diabetes Action Canada's patient engagement platform, we interviewed a purposeful sample of people with type 2 diabetes who had immigrated to Canada from: Pakistan (interviews in Urdu), China (interviews in Mandarin) and French-speaking African and Caribbean nations (interviews in French). We collected and analysed data based on the Theoretical Domains Framework covering key modifiable factors that may operate as barriers to or enablers of attending eye screening. We used directed content analysis to code barrier/enabler domains. Barriers/enablers were mapped to behaviour change techniques to inform future intervention development. RESULTS We interviewed 39 people (13 per group). Many barriers/enablers were consistent across groups, including views about harms caused by screening itself, practical appointment issues including forgetting, screening costs, wait times and making/getting to an appointment, lack of awareness about retinopathy screening, language barriers, and family and clinical support. Group-specific barriers/enablers included a preference to return to one's country of birth for screening, the impact of winter, and preferences for alternative medicine. CONCLUSION Our results can inform linguistic and culturally competent interventions to support immigrants living with diabetes in attending eye screening to prevent avoidable blindness.
Collapse
Affiliation(s)
- Zack van Allen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research on Primary Care and Services, Université Laval, Québec City, QC, Canada
| | - Michael H Brent
- Donald K Johnson Eye Institute, University Health Network, Toronto, Canada
| | - Catherine Bach
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Xiaoqin Wang
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Evidence-based Medicine Centre, Lanzhou University, Lanzhou, China
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Sarah Asad
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Zahraa Chorghay
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Hina Hakim
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research on Primary Care and Services, Université Laval, Québec City, QC, Canada
| | - Olivera Sutakovic
- Donald K Johnson Eye Institute, University Health Network, Toronto, Canada
| | - Olivia Drescher
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research on Primary Care and Services, Université Laval, Québec City, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research on Primary Care and Services, Université Laval, Québec City, QC, Canada
| | - Mary Zettl
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Janet Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Marie-Claude Tremblay
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research on Primary Care and Services, Université Laval, Québec City, QC, Canada
| | | | | | | | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| |
Collapse
|
15
|
L’Espérance A, O’Brien N, Grégoire A, Abelson J, Canfield C, Del Grande C, Dogba MJ, Fancott C, Levasseur MA, Loignon C, Majnemer A, Pomey MP, Rasiah J, Salsberg J, Santana M, Tremblay MC, Urquhart R, Boivin A. Developing a Canadian evaluation framework for patient and public engagement in research: study protocol. Res Involv Engagem 2021; 7:10. [PMID: 33632329 PMCID: PMC7905422 DOI: 10.1186/s40900-021-00255-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/04/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Patient and public engagement (PPE) in research is growing internationally, and with it, the interest for its evaluation. In Canada, the Strategy for Patient-Oriented Research has generated national momentum and opportunities for greater PPE in research and health-system transformation. As is the case with most countries, the Canadian research community lacks a common evaluation framework for PPE, thus limiting our capacity to ensure integrity between principles and practices, learn across projects, identify common areas for improvement, and assess the impacts of engagement. OBJECTIVE This project aims to build a national adaptable framework for the evaluation of PPE in research, by: 1. Building consensus on common evaluation criteria and indicators for PPE in research; 2. Defining recommendations to implement and adapt the framework to specific populations. METHODS Using a collaborative action-research approach, a national coalition of patient-oriented research leaders, (patient and community partners, engagement practitioners, researchers and health system leaders) will co-design the evaluation framework. We will develop core evaluation domains of the logic model by conducting a series of virtual consensus meetings using a nominal group technique with 50 patient partners and engagement practitioners, identified through 18 national research organizations. We will then conduct two Delphi rounds to prioritize process and impact indicators with 200 participants purposely recruited to include respondents from seldom-heard groups. Six expert working groups will define recommendations to implement and adapt the framework to research with specific populations, including Indigenous communities, immigrants, people with intellectual and physical disabilities, caregivers, and people with low literacy. Each step of framework development will be guided by an equity, diversity and inclusion approach in an effort to ensure that the participants engaged, the content produced, and the adaptation strategies proposed are relevant to diverse PPE. DISCUSSION The potential contributions of this project are threefold: 1) support a national learning environment for engagement by offering a common blueprint for collaborative evaluation to the Canadian research community; 2) inform the international research community on potential (virtual) methodologies to build national consensus on common engagement evaluation frameworks; and 3) illustrate a shared attempt to engage patients and researchers in a strategic national initiative to strengthen evaluation capacity for PPE.
Collapse
Affiliation(s)
- Audrey L’Espérance
- Center of Excellence for Partnership with patients and the public, University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - Nadia O’Brien
- Canada Research Chair in Partnership with Patients and the Public, University of Montreal Hospital Research Center, Montreal, Canada
| | - Alexandre Grégoire
- Center of Excellence for Partnership with patients and the public, University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - Julia Abelson
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | | | - Claudio Del Grande
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - Maman Joyce Dogba
- Centre de recherche en santé durable – VITAM. Department of family and Emergency Medicine. Université Laval, Quebec, Canada
| | - Carol Fancott
- Canadian Foundation for Healthcare Improvement, Ottawa, Canada
| | | | - Christine Loignon
- Centre de recherche Charles-Le Moyne – Saguenay – Lac-Saint-Jean sur les innovations en santé (CR-CSIS). Département de médecine de famille, Université de Sherbrooke, Québec, Canada
| | - Annette Majnemer
- Research Institute of the McGill University Health Centre. Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Marie-Pascale Pomey
- Center of Excellence for Partnership with patients and the public, University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
- School of Public Health, Université de Montréal, Montreal, Canada
| | - Jananee Rasiah
- Alberta SPOR SUPPORT Unit. Faculty of Health Disciplines, Athabasca University, Alberta, Canada
| | - Jon Salsberg
- Health Research Institute. University of Limerick School of Medicine, Limerick, Ireland
| | - Maria Santana
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Marie-Claude Tremblay
- Centre de recherche en santé durable – VITAM. Department of family and Emergency Medicine. Université Laval, Quebec, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Antoine Boivin
- Center of Excellence for Partnership with patients and the public, University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
- Canada Research Chair in Partnership with Patients and the Public, University of Montreal Hospital Research Center, Montreal, Canada
- Department of family and emergency medicine, Université de Montréal, Montreal, Canada
| |
Collapse
|
16
|
Massé J, Poulin G, Côté M, Tremblay MC. Patient Engagement in Medical Education During the COVID-19 Pandemic: a Critical Reflection on an Epistemic Challenge. MedEdPublish 2021. [DOI: 10.15694/mep.2021.000103.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
17
|
Tremblay MC, Bradette-Laplante M, Witteman HO, Dogba MJ, Breault P, Paquette JS, Careau E, Echaquan S. Providing culturally safe care to Indigenous people living with diabetes: Identifying barriers and enablers from different perspectives. Health Expect 2020; 24:296-306. [PMID: 33350572 PMCID: PMC8077144 DOI: 10.1111/hex.13168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/08/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022] Open
Abstract
In recent years, cultural safety has been proposed as a transformative approach to health care allowing improved consideration of Indigenous patient needs, expectations, rights and identities. This community‐based participatory study aimed to identify potential barriers and enablers to cultural safety in health care provided to Atikamekw living with diabetes in Québec, Canada. Based on a qualitative descriptive design, the study uses talking circles as a data collection strategy. Three talking circles were conducted with Atikamekw living with diabetes and caregivers, as well as with health professionals of the family medicine teaching clinic providing services to the community. Two team members performed deductive thematic analysis based on key dimensions of cultural safety. Results highlight four categories of barriers and enablers to cultural safety for Atikamekw living with diabetes, related to social determinants of health (including colonialism), health services organization, language and communication, as well as Atikamekw traditional practices and cultural perspectives of health. This study is one of the few that provides concrete suggestions to address key aspects of diabetes care in a culturally respectful way. Our findings indicate that potential enablers of cultural safety reside at different (from individual to structural) levels of change. Solutions in this matter will require strong political will and policy support to ensure intervention sustainability. Patient or public contribution Partners and patients have been involved in identifying the need for this study, framing the research question, developing the data collection tools, recruiting participants and interpreting results.
Collapse
Affiliation(s)
- Marie-Claude Tremblay
- Département de médecine familiale et médecine d'urgence, Faculté de médecine Université Laval, Québec, QC, Canada
| | - Maude Bradette-Laplante
- Département de médecine familiale et médecine d'urgence, Faculté de médecine Université Laval, Québec, QC, Canada
| | - Holly O Witteman
- Département de médecine familiale et médecine d'urgence, Faculté de médecine Université Laval, Québec, QC, Canada
| | - Maman Joyce Dogba
- Département de médecine familiale et médecine d'urgence, Faculté de médecine Université Laval, Québec, QC, Canada
| | - Pascale Breault
- Groupe de Médecine de famille universitaire du Nord de Lanaudière, Joliette, QC, Canada
| | - Jean-Sébastien Paquette
- Département de médecine familiale et médecine d'urgence, Faculté de médecine Université Laval, Québec, QC, Canada.,Groupe de Médecine de famille universitaire du Nord de Lanaudière, Joliette, QC, Canada
| | - Emmanuelle Careau
- Vice-décanat à la responsabilité sociale, Faculté de médecine Université Laval, Québec, QC, Canada
| | - Sandro Echaquan
- Centre Mihawoso, Centre de pédiatrie sociale, Manawan, QC, USA
| |
Collapse
|
18
|
Tremblay MC, Bradette-Laplante M, Bérubé D, Brière É, Moisan N, Niquay D, Dogba MJ, Légaré F, McComber A, McGavock J, Witteman HO. Engaging indigenous patient partners in patient-oriented research: lessons from a one-year initiative. Res Involv Engagem 2020; 6:44. [PMID: 32760594 PMCID: PMC7376932 DOI: 10.1186/s40900-020-00216-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 06/30/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Patient-oriented research (POR) is a specific application of participatory research that promotes active patient engagement in health research. There is a growing concern that people involved in POR do not reflect the diversity of the population such research aims to serve, but are rather those more 'easily' engaged with institutions, organizations and society. Indigenous peoples are among such groups generally underrepresented in POR. The "Indigenous patient partners platform project" was a small-scale initiative aimed to address the issue of the underrepresentation of Indigenous people in patient-oriented research by recruiting, orienting and supporting Indigenous patient partners in Québec (Canada). This article reports on the findings of an evaluation conducted at the end of the project to garner lessons and identify strategies for engaging Indigenous patient partners in patient-oriented research. METHODS The evaluation of this initiative used a case study design hinging on documentary analysis and committee member interviews. Project documents (n = 29) included agendas and meeting minutes, support documents from the orientation workshop and workshop evaluations, and tools the committee developed as part of the project. Interview participants (n = 6) were patients and organizational partners. Thematic analysis was performed by two members of the research team. Patient partners actively contributed to validating the interpretation of result and knowledge translation. RESULTS Results point to four key components of Indigenous patient partner engagement in POR: initiation of partnership, interest development, capacity building and involvement in research. Specific lessons emphasize the importance of community connections in recruiting, sustaining and motivating patient partners, the need to be flexible in the engagement process, and the importance of consistently valuing patient partner contributions and involvement. CONCLUSIONS There is a need to engage Indigenous patient partners in POR to ensure that healthcare practices, policies and research take their particular needs, stories and culture into account. While results of this evaluation are generally consistent with the existing literature on patient engagement, they offer additional insight into how to effectively engage Indigenous patient partners in research, which might also be relevant to the involvement of other marginalized populations who have been historically and systemically disempowered.
Collapse
Affiliation(s)
- Marie-Claude Tremblay
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
- Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Québec City, Canada
- VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - Maude Bradette-Laplante
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Danielle Bérubé
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Élaine Brière
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Nicole Moisan
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Daniel Niquay
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Maman-Joyce Dogba
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
- Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Québec City, Canada
- VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
- VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - Alex McComber
- Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, Canada
| | - Jonathan McGavock
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- The Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Holly O. Witteman
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
- Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Québec City, Canada
- VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| |
Collapse
|
19
|
Hamelin AM, Caux C, Désy M, Guichard A, Ouédraogo S, Tremblay MC, Vissandjée B, Godard B. Developing the culture of ethics in population health intervention research in Canada. Glob Health Promot 2020; 27:69-77. [PMID: 32400273 DOI: 10.1177/1757975920913547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Population health intervention research (PHIR) is a particular field of health research that aims to generate knowledge that contributes to the sustainable improvement of population health by enabling the implementation of cross-sectoral solutions adapted to social realities. Despite the ethical issues that necessarily raise its social agenda, the ethics of PHIR is still not very formalized. Unresolved ethical challenges may limit its focus on health equity. This contribution aims to highlight some of these issues and calls on researchers to develop a culture of ethics in PHIR. Three complementary ways are proposed: to build an ethical concept specific to this field, to promote a shared space for critical reflection on PHIR ethics, and to develop the ethical competence in PHIR for which a preliminary framework is proposed.
Collapse
Affiliation(s)
| | | | - Michel Désy
- Institut national de santé publique du Québec, Montreal, Canada
| | | | | | | | | | | |
Collapse
|
20
|
Ndjaboue R, Chipenda Dansokho S, Boudreault B, Tremblay MC, Dogba MJ, Price R, Delgado P, McComber AM, Drescher O, McGavock J, Witteman H. Patients' perspectives on how to improve diabetes care and self-management: qualitative study. BMJ Open 2020; 10:e032762. [PMID: 32354775 PMCID: PMC7213839 DOI: 10.1136/bmjopen-2019-032762] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE People living with diabetes need and deserve high-quality, individualised care. However, providing such care remains a challenge in many countries, including Canada. Patients' expertise, if acknowledged and adequately translated, could help foster patient-centred care. This study aimed to describe Expert Patients' knowledge, wisdom and advice to others with diabetes and to health professionals to improve diabetes self-management and care. DESIGN AND METHODS We recruited a convenience sample of 21 men and women. Participants were people of diverse backgrounds who are Patient Partners in a national research network (hereafter Expert Patients). We interviewed and video-recorded their knowledge, wisdom and advice for health professionals and for others with diabetes. Three researchers independently analysed videos using inductive framework analysis, identifying themes through discussion and consensus. Expert Patients were involved in all aspects of study design, conduct, analysis and knowledge translation. RESULTS Acknowledging and accepting the reality of diabetes, receiving support from family and care teams and not letting diabetes control one's life are essential to live well with diabetes. To improve diabetes care, health professionals should understand and acknowledge the impact of diabetes on patients and their families, and communicate with patients openly, respectfully, with empathy and cultural competency. CONCLUSION Expert Patients pointed to a number of areas of improvement in diabetes care that may be actionable individually by patients or health professionals, and also collectively through intergroup collaboration. Improving the quality of care in diabetes is crucial for improving health outcomes for people with diabetes.
Collapse
Affiliation(s)
- Ruth Ndjaboue
- Office of Education and Continuing Professional Development, Laval University, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency, Laval University, Quebec, Quebec, Canada
- Diabetes Action Canada, Toronto, Ontario, Canada
| | - Selma Chipenda Dansokho
- Office of Education and Continuing Professional Development, Laval University, Quebec, Quebec, Canada
| | - Bianca Boudreault
- Department of Family Medicine and Emergency, Laval University, Quebec, Quebec, Canada
| | - Marie-Claude Tremblay
- Office of Education and Continuing Professional Development, Laval University, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency, Laval University, Quebec, Quebec, Canada
- Diabetes Action Canada, Toronto, Ontario, Canada
| | - Maman Joyce Dogba
- Office of Education and Continuing Professional Development, Laval University, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency, Laval University, Quebec, Quebec, Canada
- Diabetes Action Canada, Toronto, Ontario, Canada
| | | | | | - Alex M McComber
- Diabetes Action Canada, Toronto, Ontario, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Olivia Drescher
- Office of Education and Continuing Professional Development, Laval University, Quebec, Quebec, Canada
- Diabetes Action Canada, Toronto, Ontario, Canada
| | - Jonathan McGavock
- Diabetes Action Canada, Toronto, Ontario, Canada
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Holly Witteman
- Office of Education and Continuing Professional Development, Laval University, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency, Laval University, Quebec, Quebec, Canada
- Diabetes Action Canada, Toronto, Ontario, Canada
| |
Collapse
|
21
|
Abstract
Reflexivity has emerged as a key concept in the field of health promotion
(HP). Yet it remains unclear how diverse forms of reflexivity are
specifically relevant to HP concerns, and how these “reflexivities”
are interconnected. We argue that frameworks are needed to support
more systematic integration of reflexivity in HP training and
practice. In this article, we propose a typology of reflexivity in HP
to facilitate the understanding of reflexivity in professional
training. Drawing from key theories and models of reflexivity, this
typology proposes three reflexive positions (ideal-types) with
specific purposes for HP: reflexivity in, on, and underlying action.
This article illustrates our typology’s ideal-types with vignettes
collected from HP actors working with reflexivity in North America and
Europe. We suggest that our typology constitutes a conceptual device
to organize and discuss a variety of experiences of engaging with
reflexivity for HP. We propose the typology may support integrating
reflexivity as a key feature in training a future cadre of health
promoters and as a means for building a responsible HP practice.
Collapse
Affiliation(s)
| | | | | | - Nicole Beaudet
- Montreal Health and Social Services Agency, Montreal, Canada
| | | | | |
Collapse
|
22
|
Dogba MJ, Brent MH, Bach C, Asad S, Grimshaw J, Ivers N, Légaré F, Witteman HO, Squires J, Wang X, Sutakovic O, Zettl M, Drescher O, van Allen Z, McCleary N, Tremblay MC, Linklater S, Presseau J. Identifying Barriers and Enablers to Attending Diabetic Retinopathy Screening in Immigrants to Canada From Ethnocultural Minority Groups: Protocol for a Qualitative Descriptive Study. JMIR Res Protoc 2020; 9:e15109. [PMID: 32049067 PMCID: PMC7055809 DOI: 10.2196/15109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/26/2019] [Accepted: 10/29/2019] [Indexed: 12/13/2022] Open
Abstract
Background Immigrants to Canada belonging to ethnocultural minority groups are at increased risk of developing diabetes and complications, including diabetic retinopathy, and they are also less likely to be screened and treated. Improved attendance to retinopathy screening (eye tests) has the potential to reduce permanent complications, including blindness. Objective This study aims to identify the barriers and enablers of attending diabetic retinopathy screening among ethnocultural minority immigrants living with diabetes in Quebec and Ontario, Canada, to inform the development of a behavior change intervention to improve diabetic retinopathy screening attendance. Methods The research question draws on the needs of patients and clinicians. Using an integrated knowledge translation approach, the research team includes clinicians, researchers, and patient partners who will contribute throughout the study to developing and reviewing materials and procedures, helping to recruit participants, and disseminating findings. Using a convenience snowball strategy, we will recruit participants from three target groups: South Asian and Chinese people, and French-speaking people of African descent. To better facilitate reaching these groups and support participant recruitment, we will partner with community organizations and clinics serving our target populations in Ontario and Quebec. Data will be collected using semistructured interviews, using topic guides developed in English and translated into French, Mandarin, Hindi, and Urdu, and conducted in those languages. Data collection and analysis will be structured according to the Theoretical Domains Framework (TDF), which synthesizes predominant theories of behavior change into 14 domains covering key modifiable factors that may operate as barriers or enablers to attending eye screening. We will use directed content analysis to code barriers and enablers to TDF domains, then thematic analysis to define key themes within domains. Results This study was approved for funding in December 2017, and the research ethics board approved the conduct of the study as of January 13, 2018. Data collection then began in April 2018. As of August 28, 2018, we have recruited 22 participants, and analysis is ongoing, with results expected to be published in 2020. Conclusions Findings from this study will inform the codevelopment of theory-informed, culturally- and linguistically-tailored interventions to support patients in attending retinopathy screening. International Registered Report Identifier (IRRID) DERR1-10.2196/15109
Collapse
Affiliation(s)
| | | | - Catherine Bach
- Department of Family Medicine and Emergency Medicine, Laval Unviersity, Québec, QC, Canada
| | - Sarah Asad
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jeremy Grimshaw
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Noah Ivers
- Women's Health College, Toronto, ON, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval Unviersity, Québec, QC, Canada
| | - Holly O Witteman
- Department of Family Medicine and Emergency Medicine, Laval Unviersity, Québec, QC, Canada
| | - Janet Squires
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Xiaoqin Wang
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Mary Zettl
- Department of Family Medicine and Emergency Medicine, Laval Unviersity, Québec, QC, Canada
| | - Olivia Drescher
- Department of Family Medicine and Emergency Medicine, Laval Unviersity, Québec, QC, Canada
| | - Zack van Allen
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Nicola McCleary
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marie-Claude Tremblay
- Department of Family Medicine and Emergency Medicine, Laval Unviersity, Québec, QC, Canada
| | - Stefanie Linklater
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Justin Presseau
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
23
|
Tremblay MC. The wicked interplay of hate rhetoric, politics and the internet: what can health promotion do to counter right-wing extremism? Health Promot Int 2019; 35:1-4. [DOI: 10.1093/heapro/daz124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
24
|
Bilodeau G, Witteman H, Légaré F, Lafontaine-Bruneau J, Voyer P, Kröger E, Tremblay MC, Giguere AMC. Reducing complexity of patient decision aids for community-based older adults with dementia and their caregivers: multiple case study of Decision Boxes. BMJ Open 2019; 9:e027727. [PMID: 31072861 PMCID: PMC6528048 DOI: 10.1136/bmjopen-2018-027727] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/19/2019] [Accepted: 03/14/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To identify patient decision aids' features to limit their complexity for older adults with dementia and their family caregivers. DESIGN Mixed method, multiple case study within a user-centred design (UCD) approach. SETTING Community-based healthcare in the province of Quebec in Canada. PARTICIPANTS 23 older persons (aged 65+ years) with dementia and their 27 family caregivers. RESULTS During three UCD evaluation-modification rounds, participants identified strengths and weaknesses of the patient decision aids' content and visual design that influenced their complexity. Weaknesses of content included a lack of understanding of the decision aids' purpose and target audience, missing information, irrelevant content and issues with terminology and sentence structure. Weaknesses of visual design included critics about the decision aids' general layout (density, length, navigation) and their lack of pictures. In response, the design team implemented a series of practical features and design strategies, comprising: a clear expression of the patient decision aids' purpose through simple text, picture and personal stories; systematic and frequent use of pictograms illustrating key points and helping structure patient decision aids' general layout; a glossary; removal of scientific references from the main document; personal stories to clarify more difficult concepts; a contact section to facilitate implementation of the selected option; GRADE ratings to convey the quality of the evidence; a values clarification exercise formatted as a checklist and presented at the beginning of the document to streamline navigation; involvement of a panel of patient/caregiver partners to guide expression of patient priorities; editing of the text to a sixth grade reading level; UCD process to optimise comprehensiveness and relevance of content and training of patients/caregivers in shared decision-making. CONCLUSIONS The revised template for patient decision aids is designed to meet the needs of adults living with dementia and their caregivers better, which may translate into fewer evaluation-modification rounds.
Collapse
Affiliation(s)
- Gabriel Bilodeau
- Laval University Research Centre on Primary Care and Services, Centre integre universitaire de sante et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | - Holly Witteman
- Laval University, Family and Emergency Medicine, Quebec City, Quebec, Canada
| | - France Légaré
- Knowledge Transfer and Health Technology Assessment Research Group, Research Center of Centre hospitalier universitaire de Québec (CRCHUQ), Quebec City, Quebec, Canada
- Family Medicine and Emergency Medicine, Universite Laval Faculte de medecine, Quebec City, Quebec, Canada
| | | | - Philippe Voyer
- Faculte des Sciences Infirmieres de l'Universite Laval, Quebec City, Quebec, Canada
| | - Edeltraut Kröger
- Laval University Research Center on Primary Care and Services, Centre integre universitaire de sante et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | - Marie-Claude Tremblay
- Laval University Research Centre on Primary Care and Services, Centre integre universitaire de sante et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
- Family Medicine and Emergency Medicine, Universite Laval Faculte de medecine, Quebec City, Quebec, Canada
| | - Anik M C Giguere
- Laval University Research Centre on Primary Care and Services, Centre integre universitaire de sante et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
- Family Medicine and Emergency Medicine, Laval University, Quebec City, Quebec, Canada
| |
Collapse
|
25
|
Murdoch-Flowers J, Tremblay MC, Hovey R, Delormier T, Gray-Donald K, Delaronde E, Macaulay AC. Understanding how Indigenous culturally-based interventions can improve participants' health in Canada. Health Promot Int 2019; 34:154-165. [PMID: 28973378 DOI: 10.1093/heapro/dax059] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
There is increasing recognition that culturally-based diabetes prevention programs can facilitate the adoption and maintenance of healthy behaviours in the communities in which they are implemented. The Kahnawake School Diabetes Prevention Project (KSDPP) is a health promotion, community-based participatory research project aiming to reduce the incidence of Type 2 diabetes in the community of Kahnawake (Mohawk territory, Canada), with a large range of interventions integrating a Haudenosaunee perspective of health. Building on a qualitative, naturalistic and interpretative inquiry, this study aimed to assess the outcomes of a suite of culturally-based interventions on participants' life and experience of health. Data were collected through semi-structured qualitative interviews of 1 key informant and 17 adult, female Kahnawake community members who participated in KSDPP's suite of interventions from 2007 to 2010. Grounded theory was chosen as an analytical strategy. A theoretical framework that covered the experiences of all study participants was developed from the grounded theory analysis. KSDPP's suite of interventions provided opportunities for participants to experience five different change processes: (i) Learning traditional cooking and healthy eating; (ii) Learning physical activity; (iii) Learning mind focusing and breathing techniques; (iv) Learning cultural traditions and spirituality; (v) Socializing and interacting with other participants during activities. These processes improved participants' health in four aspects: mental, physical, spiritual and social. Results of this study show how culturally-based health promotion can bring about healthy changes addressing the mental, physical, spiritual and social dimensions of a holistic concept of health, relevant to the Indigenous perspective of well-being.
Collapse
Affiliation(s)
- Jayne Murdoch-Flowers
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada.,School of Dietetics and Human Nutrition, McGill University, Montréal, QC, Canada
| | - Marie-Claude Tremblay
- Department of Family Medicine and Emergency Medicine, Office of Education and Continuing Professional Development, Université Laval, QC, Canada
| | - Richard Hovey
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada.,Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montréal, QC, Canada
| | - Treena Delormier
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada.,Office of Public Health Studies, University of Hawai'i, Honolulu, HI, USA
| | - Katherine Gray-Donald
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada.,School of Dietetics and Human Nutrition, McGill University, Montréal, QC, Canada
| | - Elaine Delaronde
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada
| | - Ann C Macaulay
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada.,Participatory Research at McGill, Department of Family Medicine, McGill University, Montréal, QC, Canada
| |
Collapse
|
26
|
Légaré F, Lee-Gosselin H, Borduas F, Monette C, Bilodeau A, Tanguay D, Stacey D, Gagnon MP, Roch G, Dogba MJ, Bussières A, Tremblay MC, Bélanger AP, Jose C, Desroches S, Robitaille H, Blair L, Rhugenda SM. Approaches to considering sex and gender in continuous professional development for health and social care professionals: An emerging paradigm. Med Teach 2018; 40:875-879. [PMID: 30058455 DOI: 10.1080/0142159x.2018.1483579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Consideration of sex and gender in research and clinical practice is necessary to redress health inequities and reduce knowledge gaps. As all health professionals must maintain and update their skills throughout their career, developing innovative continuing professional education programs that integrate sex and gender issues holds great promise for reducing these gaps. This article proposes new approaches to partnership, team development, pedagogical theory, content development, evaluation and data management that will advance the integration of sex and gender in continuing professional development (CPD). Our perspectives build on an intersectoral and interprofessional research team that includes several perspectives, including those of CPD, health systems, knowledge translation and sex and gender.
Collapse
Affiliation(s)
- France Légaré
- a Université Laval Primary Care Research Centre (CERSSPL-UL) , Quebec City , QC , Canada
- b Faculty of Medicine , Université Laval , Quebec City , QC , Canada
| | - Hélène Lee-Gosselin
- c Institute for Women, Societies, Equality and Equity , Université Laval , Quebec City , QC , Canada
| | | | - Céline Monette
- d Médecins Francophone du Canada , Montreal , QC , Canada
| | | | - Dominique Tanguay
- c Institute for Women, Societies, Equality and Equity , Université Laval , Quebec City , QC , Canada
| | - Dawn Stacey
- f School of Nursing Faculty of Health Sciences , University of Ottawa , Ottawa , ON , Canada
- g Ottawa Hospital Research Institute , Ottawa , ON , Canada
| | | | - Geneviève Roch
- h Faculty of Nursing , Université Laval , Quebec City , QC , Canada
- i CHU de Québec, Université Laval Research Centre , Quebec City , QC , Canada
| | - Maman Joyce Dogba
- a Université Laval Primary Care Research Centre (CERSSPL-UL) , Quebec City , QC , Canada
- b Faculty of Medicine , Université Laval , Quebec City , QC , Canada
| | - André Bussières
- j Faculty of Medicine , McGill University , Montreal , QC , Canada
| | | | | | - Caroline Jose
- l Department of Family Medicine , University of Sherbrooke , Moncton , NB , Canada
- m Maritimes SPOR Support Unit , Moncton , NB , Canada
| | - Sophie Desroches
- n Institute of Nutrition and Functional Foods , School of Nutrition , Université Laval , Quebec City , QC , Canada
| | - Hubert Robitaille
- a Université Laval Primary Care Research Centre (CERSSPL-UL) , Quebec City , QC , Canada
| | - Louisa Blair
- a Université Laval Primary Care Research Centre (CERSSPL-UL) , Quebec City , QC , Canada
| | | |
Collapse
|
27
|
Tremblay MC, Martin DH, McComber AM, McGregor A, Macaulay AC. Understanding community-based participatory research through a social movement framework: a case study of the Kahnawake Schools Diabetes Prevention Project. BMC Public Health 2018; 18:487. [PMID: 29650020 PMCID: PMC5897940 DOI: 10.1186/s12889-018-5412-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 04/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A longstanding challenge of community-based participatory research (CBPR) has been to anchor evaluation and practice in a relevant theoretical framework of community change, which articulates specific and concrete evaluative benchmarks. Social movement theories provide a broad range of theoretical tools to understand and facilitate social change processes, such as those involved in CBPR. Social movement theories have the potential to provide a coherent representation of how mobilization and collective action is gradually developed and leads to systemic change in the context of CBPR. The current study builds on a social movement perspective to assess the processes and intermediate outcomes of a longstanding health promotion CBPR project with an Indigenous community, the Kahnawake Schools Diabetes Prevention Project (KDSPP). METHODS This research uses a case study design layered on a movement-building evaluation framework, which allows progress to be tracked over time. Data collection strategies included document (scientific and organizational) review (n = 51) and talking circles with four important community stakeholder groups (n = 24). RESULTS Findings provide an innovative and chronological perspective of the evolution of KSDPP as seen through a social movement lens, and identify intermediate outcomes associated with different dimensions of movement building achieved by the project over time (mobilization, leadership, vision and frames, alliance and partnerships, as well as advocacy and action strategies). It also points to areas of improvement for KSDPP in building its potential for action. CONCLUSION While this study's results are directly relevant and applicable to the local context of KSDPP, they also highlight useful lessons and conclusions for the planning and evaluation of other long-standing and sustainable CBPR initiatives. The conceptual framework provides meaningful benchmarks to track evidence of progress in the context of CBPR. Findings from the study offer new ways of thinking about the evaluation of CBPR projects and their progress by drawing on frameworks that guide other forms of collective action.
Collapse
Affiliation(s)
- Marie-Claude Tremblay
- Department of Family Medicine and Emergency Medicine, Office of Education and Continuing Professional Development, Université Laval, 1050, de la Médecine, Pavillon Ferdinand-Vandry, 2881-F, Québec, QC, G1V 0A6, Canada.
| | - Debbie H Martin
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Alex M McComber
- Kahnawake Schools Diabetes Prevention Project, Kahnawake, QC, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Amelia McGregor
- Kahnawake Schools Diabetes Prevention Project, Kahnawake, QC, Canada
| | - Ann C Macaulay
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| |
Collapse
|
28
|
Guicherd-Callin LB, Doré I, Tremblay MC, Beauchamp J, Parent AA. Une formation complémentaire et appliquée : un besoin pour la relève en recherche interventionnelle en santé des populations. Can J Public Health 2018; 109:272-275. [PMID: 29981030 PMCID: PMC6964786 DOI: 10.17269/s41997-018-0039-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/10/2017] [Indexed: 11/17/2022]
Abstract
Population Health Intervention Research (PHIR) is an emerging and distinct field that combines scientific research and public health practice. However, traditional academic training in research, which is founded on specific disciplinary orientations, does not sufficiently inform and prepare new PHIR researchers. In this commentary, we advance the idea that PHIR requires a broader range of competencies and knowledge that must be developed through a complementary and applied training program. Drawing on our experience as 4P Strategic Training Program fellows, we identified key elements of the program that have helped prepare us in our careers as future and new PHIR researchers. We believe that complementary and applied training programs such as the 4P Program are a promising strategy in training and supporting the next generation of PHIR researchers in their efforts to improve population health.
Collapse
Affiliation(s)
- Lilian Bernard Guicherd-Callin
- Département des Sciences de l'activité Physique, Faculté des Sciences, Université du Québec à Montréal, Case postale 8888, Succursale Centre-ville, Montréal, Québec, H3C 3P8, Canada.
| | - Isabelle Doré
- Faculté de Kinésiologie et d'Éducation Physique, Université de Toronto, Toronto, Ontario, Canada
| | - Marie-Claude Tremblay
- Département de Médecine familiale et médecine d'urgence, Université Laval, Québec, Québec, Canada
| | - Julie Beauchamp
- Département de Sexologie, Faculté des Sciences Humaines, Université du Québec à Montréal, Montréal, Québec, Canada
| | - André-Anne Parent
- École de Travail Social, Centre de Recherche et de Partage des Savoirs Interactions du CIUSSS du Nord-de-l'Île-de-Montréal, Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
29
|
Bisset S, Tremblay MC, Wright MT, Poland B, Frohlich KL. Can reflexivity be learned? An experience with tobacco control practitioners in Canada. Health Promot Int 2017; 32:167-176. [PMID: 28180263 DOI: 10.1093/heapro/dav080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Summary To explore an example of a reflexive intervention with health professionals working in tobacco control (TC). This study reports the perceived intervention effects regarding: (i) participants' understanding of reflexivity and personal learning and (ii) conditions needed in order to integrate reflexivity into professional and organizational practices. This is a qualitative study using an interpretative evaluation framework to assess the perceived effects of a reflexive intervention in Montréal, Québec. Semi-structured qualitative interviews (n = 8) gathered data. Data analysis began deductively, guided by the broad categories found in research questions. Sub-categories to populate these broad categories captured the inhibitors and facilitators through an inductive thematic analysis. Our study reveals that, following the intervention, most participants had a generally good understanding of reflexivity and described concrete learning in association with the intervention. Main facilitators and inhibitors to conducting a reflexive workshop pertained to the organizational context as well as to the professional and individual characteristics of the participants. Some participants implemented sustainable changes as a result of the intervention, such as creating a tool, reviewing work plans and developing new mechanisms to integrate the voice of their clientele in the planning process. The need and interest for dialogue among health professionals about how TC intervention activities may inadvertently contribute to social inequalities in smoking is apparent. While there appears to be potential for reflexive practice, the integration of reflexivity into practice is reliant upon the organizational context (financial and time constraints, culture, support, and climate) and the reflexivity concept itself (intangibility, complexity and fuzziness).
Collapse
Affiliation(s)
- S Bisset
- Centre de Recherche de l'Hôpital Charles-Le Moyne (CR-CLM), Direction de Santé Publique de Montérégie, 1255, rue Beauregard, Longueuil, Québec, Canada J4K 2M3
| | - M C Tremblay
- Department of Family Medicine, McGill University, Montreal, Canada
| | - M T Wright
- Institute for Social Health, Catholic University of Applied Sciences Berlin, Berlin, Germany
| | - B Poland
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - K L Frohlich
- Département de Médecine Sociale et Preventive, ESPUM/IRSPUM, Université de Montréal, Montréal, Canada
| |
Collapse
|
30
|
Richard L, Torres S, Tremblay MC, Chiocchio F, Litvak É, Fortin-Pellerin L, Beaudet N. An analysis of the adaptability of a professional development program in public health: results from the ALPS Study. BMC Health Serv Res 2015; 15:233. [PMID: 26072223 PMCID: PMC4465469 DOI: 10.1186/s12913-015-0903-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 06/03/2015] [Indexed: 11/25/2022] Open
Abstract
Background Professional development is a key component of effective public health infrastructures. To be successful, professional development programs in public health and health promotion must adapt to practitioners’ complex real-world practice settings while preserving the core components of those programs’ models and theoretical bases. An appropriate balance must be struck between implementation fidelity, defined as respecting the core nature of the program that underlies its effects, and adaptability to context to maximize benefit in specific situations. This article presents a professional development pilot program, the Health Promotion Laboratory (HPL), and analyzes how it was adapted to three different settings while preserving its core components. An exploratory analysis was also conducted to identify team and contextual factors that might have been at play in the emergence of implementation profiles in each site. Methods This paper describes the program, its core components and adaptive features, along with three implementation experiences in local public health teams in Quebec, Canada. For each setting, documentary sources were analyzed to trace the implementation of activities, including temporal patterns throughout the project for each program component. Information about teams and their contexts/settings was obtained through documentary analysis and semi-structured interviews with HPL participants, colleagues and managers from each organization. Results While each team developed a unique pattern of implementing the activities, all the program’s core components were implemented. Differences of implementation were observed in terms of numbers and percentages of activities related to different components of the program as well as in the patterns of activities across time. It is plausible that organizational characteristics influencing, for example, work schedule flexibility or learning culture might have played a role in the HPL implementation process. Conclusions This paper shows how a professional development program model can be adapted to different contexts while preserving its core components. Capturing the heterogeneity of the intervention’s exposure, as was done here, will make possible in-depth impact analyses involving, for example, the testing of program–context interactions to identify program outcomes predictors. Such work is essential to advance knowledge on the action mechanisms of professional development programs. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0903-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lucie Richard
- IRSPUM, Université de Montréal, P.O. Box 6128, Centre-ville Station, Montréal, QC, H3C 3 J7, Canada. .,Faculty of Nursing, Université de Montréal, Montréal, Canada. .,Léa-Roback Research Centre on Social Inequalities of Health in Montréal, Université de Montréal, Montréal, Canada.
| | - Sara Torres
- IRSPUM, Université de Montréal, P.O. Box 6128, Centre-ville Station, Montréal, QC, H3C 3 J7, Canada.
| | - Marie-Claude Tremblay
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, 3rd floor, Montreal, QC, H3S 1Z1, Canada.
| | - François Chiocchio
- Telfer School of Management, University of Ottawa, 55 Laurier Ave. East, Ottawa, ON, K1N 6 N5, Canada. .,Institut de recherche de l'Hôpital Montfort, Ottawa, ON, Canada.
| | - Éric Litvak
- Public Health Directorate for Montreal, Montreal Health and Social Services Agency, 1301 Sherbrooke St. East, Montreal, QC, H2L 1 M3, Canada.
| | - Laurence Fortin-Pellerin
- IRSPUM, Université de Montréal, P.O. Box 6128, Centre-ville Station, Montréal, QC, H3C 3 J7, Canada
| | - Nicole Beaudet
- Public Health Directorate for Montreal, Montreal Health and Social Services Agency, 1301 Sherbrooke St. East, Montreal, QC, H2L 1 M3, Canada. .,Department of Social and Preventive Medicine, Université de Montréal, Montréal, Canada.
| |
Collapse
|
31
|
Tremblay MC, Pluye P, Gore G, Granikov V, Filion KB, Eisenberg MJ. Regulation profiles of e-cigarettes in the United States: a critical review with qualitative synthesis. BMC Med 2015; 13:130. [PMID: 26041672 PMCID: PMC4480885 DOI: 10.1186/s12916-015-0370-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/15/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) have been steadily increasing in popularity since their introduction to US markets in 2007. Debates surrounding the proper regulatory mechanisms needed to mitigate potential harms associated with their use have focused on youth access, their potential for nicotine addiction, and the renormalization of a smoking culture. The objective of this study was to describe the enacted and planned regulations addressing this novel public health concern in the US. METHODS We searched LexisNexis Academic under Federal Regulations and Registers, as well as State Administrative Codes and Registers. This same database was also used to find information about planned regulations in secondary sources. The search was restricted to US documents produced between January 1(st), 2004, and July 14(th), 2014. RESULTS We found two planned regulations at the federal level, and 74 enacted and planned regulations in 44 states. We identified six state-based regulation types, including i) access, ii) usage, iii) marketing and advertisement, iv) packaging, v) taxation, and vi) licensure. These were further classified into 10 restriction subtypes: sales, sale to minors, use in indoor public places, use in limited venues, use by minors, licensure, marketing and advertising, packaging, and taxation. Most enacted restrictions aimed primarily to limit youth access, while few regulations enforced comprehensive restrictions on product use and availability. CONCLUSIONS Current regulations targeting e-cigarettes in the US are varied in nature and scope. There is greater consensus surrounding youth protection (access by minors and/or use by minors, and/or use in limited venues), with little consensus on multi-level regulations, including comprehensive use bans in public spaces.
Collapse
Affiliation(s)
- Marie-Claude Tremblay
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC, H3S 1Z1, Canada.
| | - Pierre Pluye
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC, H3S 1Z1, Canada.
| | - Genevieve Gore
- Life Sciences Library, McGill University, 3655 Promenade Sir William Osler, Montreal, QC, H3G 1Y6, Canada.
| | - Vera Granikov
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC, H3S 1Z1, Canada.
| | - Kristian B Filion
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Côte-Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada. .,Division of Clinical Epidemiology, Jewish General Hospital, 3755 Côte-Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada.
| | - Mark J Eisenberg
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Côte-Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada. .,Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, 3755 Côte-Ste-Catherine Road, Suite H-421.1, Montreal, QC, H3T 1E2, Canada.
| |
Collapse
|
32
|
Affiliation(s)
- Adam P. Treder
- Département
de Pharmacologie, Institut de Pharmacologie de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada J1H 5N4
| | - Marie-Claude Tremblay
- Département
de Pharmacologie, Institut de Pharmacologie de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada J1H 5N4
| | - Andrei K. Yudin
- Department
of Chemistry, University of Toronto, Davenport Building, rm. 362, 80
St. George, Toronto, ON, Canada M5S 3H6
| | - Eric Marsault
- Département
de Pharmacologie, Institut de Pharmacologie de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada J1H 5N4
| |
Collapse
|
33
|
Tremblay MC, Parent AA. Reflexivity in PHIR: let's have a reflexive talk! Can J Public Health 2014; 105:e221-3. [PMID: 25165844 PMCID: PMC6972395 DOI: 10.17269/cjph.105.4438] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/26/2014] [Accepted: 04/21/2014] [Indexed: 11/17/2022]
Abstract
In 2009, a group of researchers who gathered in the context of the Population Health Intervention Research Initiative for Canada (PHIRIC) agreed upon the need to define a specific set of competencies for population health intervention research (PHIR). Following this event, a consultative process allowed the definition of six domains of core competencies in PHIR, which were released for the first time last summer. In this comment, we would like to respond to this set of competencies and, more specifically, to the "reflective researcher" domain of the competencies. We believe that propositions in this domain are rooted in a narrow and oversimplified definition of reflexivity. Furthermore, we are concerned that disseminating such propositions is not only misleading but could also encourage a false practice of reflexivity, impeding the evolution of the PHIR field and its capacity to improve population health. In order to illustrate our point, we build on commonly accepted definitions of reflexivity to critically examine the initial propositions of the group and suggest new ones. As researchers in the population health intervention field, we believe that a more accurate definition of what is a reflective researcher is crucial in order to foster the continuous development of the field and its capacity to improve population health.
Collapse
|
34
|
Richard L, Chiocchio F, Tremblay MC, Lamy G, Champagne F, Beaudet N. Communities of Practice as a Professional and Organizational Development Strategy in Local Public Health Organizations in Quebec, Canada: An Evaluation Model. Healthc Policy 2014. [DOI: 10.12927/hcpol.2014.23731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
35
|
Richard L, Chiocchio F, Essiembre H, Tremblay MC, Lamy G, Champagne F, Beaudet N. Communities of practice as a professional and organizational development strategy in local public health organizations in Quebec, Canada: an evaluation model. Healthc Policy 2014; 9:26-39. [PMID: 24726072 PMCID: PMC3999567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Communities of practice (CoPs) are among the professional development strategies most widely used in such fields as management and education. Though the approach has elicited keen interest, knowledge pertaining to its conceptual underpinnings is still limited, thus hindering proper assessment of CoPs' effects and the processes generating the latter. To address this shortcoming, this paper presents a conceptual model that was developed to evaluate an initiative based on a CoP strategy: Health Promotion Laboratories are a professional development intervention that was implemented in local public health organizations in Montreal (Quebec, Canada). The model is based on latest theories on work-group effectiveness and organizational learning and can be usefully adopted by evaluators who are increasingly called upon to illuminate decision-making about CoPs. Ultimately, validation of this conceptual model will help advance knowledge and practice pertaining to CoPs as well as professional and organizational development strategies in public health.
Collapse
Affiliation(s)
- Lucie Richard
- Full Professor, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), Faculty of Nursing, Léa-Roback Research Centre on Social Inequalities of Health in Montreal, and Research Centre, Institut universitaire de gériatrie de Montréal, Université de Montréal Montreal, QC
| | - François Chiocchio
- Associate Professor, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM) and Department of Psychology, Université de Montréal, Montreal, QC
| | - Hélène Essiembre
- Research Associate, Department of Psychology, Université de Montréal, Montreal, QC
| | - Marie-Claude Tremblay
- Graduate Student, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM) and School of Public Health Université de Montréal, Montreal Public Health Department, Montreal Health and Social Services Agency, Montreal, QC
| | - Geneviève Lamy
- Research Associate, Montreal Public Health Department, Montreal Health and Social Services Agency, Montreal, QC
| | - François Champagne
- Full Professor, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM) and School of Public Health, Université de Montréal, Montreal, QC
| | - Nicole Beaudet
- Planning, Programming and Research Officer, School of Public Health, Université de Montréal Montreal Public Health Department, Montreal Health and Social Services Agency, Montreal, QC
| |
Collapse
|
36
|
Tremblay MC, Brousselle A, Richard L, Beaudet N. Defining, illustrating and reflecting on logic analysis with an example from a professional development program. Eval Program Plann 2013; 40:64-73. [PMID: 23807118 DOI: 10.1016/j.evalprogplan.2013.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 05/16/2013] [Accepted: 05/27/2013] [Indexed: 06/02/2023]
Abstract
Program designers and evaluators should make a point of testing the validity of a program's intervention theory before investing either in implementation or in any type of evaluation. In this context, logic analysis can be a particularly useful option, since it can be used to test the plausibility of a program's intervention theory using scientific knowledge. Professional development in public health is one field among several that would truly benefit from logic analysis, as it appears to be generally lacking in theorization and evaluation. This article presents the application of this analysis method to an innovative public health professional development program, the Health Promotion Laboratory. More specifically, this paper aims to (1) define the logic analysis approach and differentiate it from similar evaluative methods; (2) illustrate the application of this method by a concrete example (logic analysis of a professional development program); and (3) reflect on the requirements of each phase of logic analysis, as well as on the advantages and disadvantages of such an evaluation method. Using logic analysis to evaluate the Health Promotion Laboratory showed that, generally speaking, the program's intervention theory appeared to have been well designed. By testing and critically discussing logic analysis, this article also contributes to further improving and clarifying the method.
Collapse
Affiliation(s)
- Marie-Claude Tremblay
- Département de médecine sociale et préventive, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal (Québec) H3C 3J7, Canada.
| | | | | | | |
Collapse
|
37
|
Tremblay MC, Richard L, Brousselle A, Beaudet N. Learning reflexively from a health promotion professional development program in Canada. Health Promot Int 2013; 29:538-48. [PMID: 23996539 DOI: 10.1093/heapro/dat062] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In recent decades, reflexivity has received much attention in the professional education and training literature, especially in the public health and health promotion fields. Despite general agreement on the importance of reflexivity, there appears to be no consensus on how to assess reflexivity or to conceptualize the different forms developed among professionals and participants of training programs. This paper presents an analysis of the reflexivity outcomes of the Health Promotion Laboratory, an innovative professional development program aimed at supporting practice changes among health professionals by fostering competency development and reflexivity. More specifically, this paper explores the difference between two levels of reflexivity (formative and critical) and highlights some implications of each for practice. Data were collected through qualitative interviews with participants from two intervention sites. Results showed that involvement in the Health Promotion Laboratory prompted many participants to modify their vision of their practice and professional role, indicating an impact on reflexivity. In many cases, new understandings seem to have played a formative function in enabling participants to improve their practice and their role as health promoters. The reflective process also served a critical function culminating in a social and moral understanding of the impacts on society of the professionals' practices and roles. This type of outcome is greatly desired in health promotion, given the social justice and equity concerns of this field of practice. By redefining the theoretical concept of reflexivity on two levels and discussing their impacts on practice, this study supports the usefulness of both levels of reflexivity.
Collapse
Affiliation(s)
- Marie-Claude Tremblay
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Montreal, Montreal, QC, Canada University of Montreal Public Health Research Institute (IRSPUM; Institut de recherche en santé publique de l'Université de Montréal), Montreal, QC, Canada
| | - Lucie Richard
- University of Montreal Public Health Research Institute (IRSPUM; Institut de recherche en santé publique de l'Université de Montréal), Montreal, QC, Canada Faculty of Nursing, University of Montreal, Montreal, QC, Canada
| | - Astrid Brousselle
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Canada Charles LeMoyne Hospital Research Centre, Longueuil, QC, Canada
| | - Nicole Beaudet
- Public Health Directorate for Montreal, Montreal Health and Social Services Agency, Montreal, QC, Canada
| |
Collapse
|
38
|
Tremblay MC, Richard L, Brousselle A, Beaudet N. How can both the intervention and its evaluation fulfill health promotion principles? An example from a professional development program. Health Promot Pract 2012; 14:563-71. [PMID: 23159998 DOI: 10.1177/1524839912462030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The emergence over the past 20 years of health promotion discourse poses a specific challenge to public health professionals, who must come to terms with new roles and new intervention strategies. Professional development is, among other things, a lever for action to be emphasized in order to meet these challenges. To respond to the specific training needs of public health professionals, a team from the Direction de santé publique de Montréal (Montreal Public Health Department) in Quebec, Canada, established in 2009 the Health Promotion Laboratory, an innovative professional development project. An evaluative component, which supports the project's implementation by providing feedback, is also integrated into the project. This article seeks to demonstrate that it is possible to integrate the basic principles of health promotion into a professional development program and its evaluation. To this end, it presents an analytical reading of both the intervention and its evaluation component in light of the cardinal principles in this field. Initiatives such as the Health Promotion Laboratory and its evaluation are essential to consolidate the foundations of professional development and its assessment by concretely integrating health promotion discourse into these practices.
Collapse
|
39
|
Tremblay MC, Sabourin L. Comparing behavioral discrimination and learning abilities in monolinguals, bilinguals and multilinguals. J Acoust Soc Am 2012; 132:3465-3474. [PMID: 23145626 DOI: 10.1121/1.4756955] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The aim of the experiment was to determine whether language learning experience contributes to the development of enhanced speech perception abilities. Monolinguals, bilinguals and multilinguals were compared in their ability to discriminate a non-native contrast behaviorally using an AX task. The experiment was based on a "pre-test-training-post-test" design and performance was tested before and after receiving training on the voiceless aspirated dental/retroflex stop contrast. At post-test, participants were also tested on their ability to transfer training to a similar contrast (i.e., voiceless unaspirated dental/retroflex stop contrast). While no group differences were found at pre-test, analyses of the trained-on contrast at post-test revealed that multilinguals were more accurate than monolinguals and that both the multilingual and bilingual groups were more accurate than a control group that received no training. The results of the experiment not only suggest that multilinguals and bilinguals have enhanced speech perception abilities compared to monolinguals, but they also indicate that bi-/multilingualism helps develop superior learning abilities. This provides support for the idea that learning more than one language has positive effects on the cognitive development of an individual (e.g., Bialystok et al., 2004).
Collapse
Affiliation(s)
- Marie-Claude Tremblay
- Department of Linguistics, University of Ottawa, 70 Laurier Avenue, Arts Building, room 439, Ottawa, ON K1N 6N5, Canada.
| | | |
Collapse
|
40
|
Guérin B, Ait-Mohand S, Tremblay MC, Dumulon-Perreault V, Fournier P, Bénard F. Total Solid-Phase Synthesis of NOTA-Functionalized Peptides for PET Imaging. Org Lett 2009; 12:280-3. [DOI: 10.1021/ol902601x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Brigitte Guérin
- Centre d’imagerie moléculaire de Sherbrooke (CIMS), Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, Québec, Canada J1H 5N4, and Department of Molecular Oncology, BC Cancer Agency Research Centre, and Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Samia Ait-Mohand
- Centre d’imagerie moléculaire de Sherbrooke (CIMS), Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, Québec, Canada J1H 5N4, and Department of Molecular Oncology, BC Cancer Agency Research Centre, and Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Marie-Claude Tremblay
- Centre d’imagerie moléculaire de Sherbrooke (CIMS), Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, Québec, Canada J1H 5N4, and Department of Molecular Oncology, BC Cancer Agency Research Centre, and Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Véronique Dumulon-Perreault
- Centre d’imagerie moléculaire de Sherbrooke (CIMS), Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, Québec, Canada J1H 5N4, and Department of Molecular Oncology, BC Cancer Agency Research Centre, and Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Patrick Fournier
- Centre d’imagerie moléculaire de Sherbrooke (CIMS), Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, Québec, Canada J1H 5N4, and Department of Molecular Oncology, BC Cancer Agency Research Centre, and Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - François Bénard
- Centre d’imagerie moléculaire de Sherbrooke (CIMS), Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, Québec, Canada J1H 5N4, and Department of Molecular Oncology, BC Cancer Agency Research Centre, and Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
41
|
Spino C, Tremblay MC, Godbout C. A Stereodivergent Approach To Amino Acids, Amino Alcohols, or Oxazolidinones of High Enantiomeric Purity. Org Lett 2005. [DOI: 10.1021/ol050537n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
42
|
Spino C, Tremblay MC, Godbout C, Gobdout C. A Stereodivergent Approach to Amino Acids, Amino Alcohols, or Oxazolidinones of High Enantiomeric Purity. Org Lett 2004; 6:2801-4. [PMID: 15281773 DOI: 10.1021/ol048936q] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
(-)-Menthone, an inexpensive chiral auxiliary, was used to prepare both enantiomers of alpha-amino acids, amino alcohols, or oxazolidinones. The sequence includes the S(N)2' displacement by a cuprate reagent and a Curtius rearrangement as key steps.
Collapse
Affiliation(s)
- Claude Spino
- Département de Chimie, Université de Sherbrooke, 2500 Boulevard Université, Sherbrooke, Quebec, Canada J1K 2R1.
| | | | | | | |
Collapse
|
43
|
Spino C, Granger MC, Tremblay MC. Increased Felkin-Anh selectivity using AlMe(3) in the addition of vinyllithiums to alpha-chiral aldehydes: do "ate" complexes play any role? Org Lett 2002; 4:4735-7. [PMID: 12489974 DOI: 10.1021/ol027236n] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
[reaction: see text] AlMe(3) dramatically increases the diastereoselectivity of addition of vinyllithiums to alpha-chiral aldehydes but decreases that of methyllithium. Our results are explained in terms of an addition of the free vinyllithium on the Me(3)Al-aldehyde complex.
Collapse
Affiliation(s)
- Claude Spino
- Université de Sherbrooke, Département de Chimie, Sherbrooke, Qc, Canada, J1K 2R1.
| | | | | |
Collapse
|
44
|
Abstract
PURPOSE To study the outcome of corneal transplants performed with cryopreserved tissue. METHODS Maisonneuve-Rosemont Hospital medical records of all corneal transplantations performed with cryopreserved tissue by one surgeon (M.L.F.) between March 1978 and April 1991 were reviewed. The Kaufman--Capella cryopreservation technique was used. Corneas were cryopreserved for periods of 3 days to 16.8 years (mean, 4.6 years) before transplantation. RESULTS We report a mean follow-up of 54 months (range, 2.8--151.3 months). Survival analysis showed the probability of a clear graft to be 76% at 1 year and 73.2% at 2 years. At the time of the last visit, visual acuity was 20/40 or better in 61 eyes (49.2%). The mean postoperative pachometry was 0.58 mm (range, 0.50--0.75 mm). Specular microscopy performed in 57 eyes showed a mean endothelial cell count of 938 cells/mm(2) 55.1 months (range, 2.9--151.3 months) after surgery. For comparison purposes, the outcome of a subgroup of cryopreserved (n = 33) and noncryopreserved (n = 26) corneas transplanted by the same surgeon between April 1986 and April 1990 was studied. CONCLUSION Despite an increase in the primary failure rate and higher initial endothelial cell loss, cryopreserved transplants are viable. Although we do not recommend cryopreservation of corneas for elective surgery, we consider that cryopreserved corneas can be very useful in emergency situations when tissue availability is a problem.
Collapse
Affiliation(s)
- I Brunette
- Department of Ophthalmology, University of Montreal, Montreal, Canada
| | | | | | | |
Collapse
|