Interactive Domain Model (IDM) / Modèle des domaines interactifs (MDI) Developing a user-friendly context-sensitive best practices approach to achieve health promotion & public health goals Barbara Kahan (Member, Centre for Health Promotion, University of Toronto) Christiane Fontaine (Consultant, Ontario Prevention Clearinghouse) Peggy Schultz (Consultant, Ontario Prevention Clearinghouse) Michael Goodstadt (Member, Centre for Health Promotion, University of Toronto)

Toronto (Canada), March 10-11, 2005 poster display for A Workshop on the Canadian Best Practices System for Chronic Disease Prevention Toronto (Canada), March 10-11, 2005

IDM/MDI information & resources are available from: www.idmbestpractices.ca www.opc.on.ca/francais/nosprogrammes/ centre/projets/meilleurespratiques.htm www.bestpractices-healthpromotion.com www.utoronto.ca/chp/bestp.html

IDM/MDI definition of best practices Best practices are those sets of processes and activities which are consistent with health promotion/public health values, goals and ethics, theories and beliefs, evidence, and understanding of the environment, and that are most likely to achieve health promotion/public health goals in any given situation. In brief, the IDM approach is about increasing consistency between practice and a range of decision making factors such as values, theories, beliefs, evidence, and understanding of the environment.

Définition des meilleures pratiques Ensemble des processus et activités les plus susceptibles d’atteindre les objectifs de promotion de la santé dans une situation donnée tout en respectant les valeurs, buts, principes éthiques, théories, croyances, constatations et contextes environnementaux de la promotion de la santé. En résumé, l’approche du modèle des Domaines interactifs permet d’être consistent entre la pratique et les facteurs qui peuvent influencer la prise de décision (valeurs, théories, croyances et l’environnement)

Les meilleures pratiques en promotion de la santé •Permet de maximiser les avantages associés à des meilleures pratiques et d’en minimiser les risques potentiels en promotion de la santé et •Prend en considération : • tous les facteurs importants qui influencent la pratique; • les circonstances uniques de chaque situation; • la relation entre les procédés (processus) et résultats.

Le Modèle des domaines interactifs (MDI) … •Peut servir d’outil de planification, d’implantation et d’évaluation que ce soit pour un projet, un programme ou un exercice de planification stratégique; •Permet une cohérence entre les valeurs et les activités qui découlent de la planification; •C’est un outil qui encourage la discussion portant sur le développement d’une vision commune et des valeurs partagées au sein du groupe qui l’utilise; •Met en évidence une approche basée sur la promotion de la santé; •Son application qui ne se limite pas au domaine de la promotion de la santé mais il est aussi adaptable culturellement et linguistiquement et ce, dans différents milieux de travail.  

Le MDI permet… de jeter un regard critique qui nous permet de faire des choix et prendre des décisions (p.ex. pratique actuelle ou proposée) basés sur des données probantes; d’analyser plus profondément les lacunes et les besoins: ce que l’on doit changer, arrêter, commencer ou continuer;  de développer un plan d’action qui assure une cohérence entre les objectifs, activités et évaluation sont cohérentes entre eux;  et d’avoir un regard critique sur ce qui a été fait (évaluation).

Timeline: 1996-1997 Practitioners at the International Symposium on the Effectiveness of Health Promotion express a desire to actively participate in resolving issues related to evaluation and effectiveness of health promotion. The Centre for Health Promotion, University of Toronto, creates the Continuous Quality Improvement (CQI) Work Group; members represent a variety of sectors:  public health units  community health centres  hospitals  community groups  provincial government  federal government  academic institutions  private sector Health Canada, Population and Public Health Branch (currently Public Health Agency of Canada, Ontario and Nunavut Region), funder of the Symposium, also funds the next five years of what becomes the Best Practices Project. CQI Work Group Members clarify their understanding of concepts and practices related to CQI and how CQI might contribute to health promotion practice.

Timeline: 1997-1998 A literature review and synthesis by one of the members results in two background papers (on CQI and best practices) for reference use by the CQI Work Group. Members decide to become the Best Practices Work Group. Members participate in a series of hands-on workshops. Through these workshops they explore best practices, in the process identifying potential benefits and risks and developing their own set of best practices principles.

Timeline: 1998-1999 The original best practices Model evolves. It is now based on three interactive components or “domains” which exist in the context of social, political, psychological, and physical environments: underpinnings, understanding of the environment, and practice. A Framework, designed to implement the Model in practice, is developed. It contains a cycle of steps which are applied to the Model’s domains. The Framework’s questions are:  Where are we now?  Where do we want to go?  How do we get there?  What principles guide us?  What did we do?  How did we do it?  What were the results?  What do we need to change? A set of suggested guiding principles and criteria is drafted.

Timeline: 1998-1999 continued The Work Group conducts an Ontario scan of practitioners’ needs and capacities regarding best practices, using interviews and a survey. A years-long series of national and international workshops, presentations and consultations begins with groups ranging from the Ontario Public Health Association to the International Union of Health Promotion and Education. The Centre for Health Promotion’s Best Practices Work Group joins with the Association of Ontario Health Centres and the Ontario Public Health Benchmarking Partnership to form the Best Practices Partnership.

Timeline: 1999-2000 The Best Practices Partnership pilots the draft IDM approach (based on the Model and its operational Framework) with three Ontario sites: - Durham Region Health Department - East End Community Health Centre (TO) - The Willett Hospital (Paris) Facilitators consult extensively with each site to take into account local internal and external conditions. As a result, focus issues and processes for working through the Framework vary from site to site. Facilitators conduct workshops and provide supporting materials to introduce basic concepts. In between workshops site participants work to develop their own frameworks, contacting the facilitators as required when questions arise.

Timeline: 1999-2000 continued Positive pilot test results include:  for the approach: confirmation that the Model and Framework are flexible enough to be used in different situations, in different ways, and for different purposes; and, identification of ways to improve IDM processes and materials (e.g. gaps to fill, concepts to clarify, explanations to reword, exercises to reorganize, essential supports to put in place)  for one or more sites: increases in knowledge, skills, understanding, group cohesion, consensus, enthusiasm, systematic planning, credibility, and ability to identify and address work- related issues (e.g. clinical vs. non-clinical perspectives, restructuring, funding) Possible negative/lack of impact on individual pilot sites include: volunteer disaffection, resistance, no change in planning process. Based on facilitator and participant observations and evaluation results (group discussions and written feedback) the Framework and materials are modified.

Timeline: 1999-2000 continued The Francophone sub-committee is formed, with a mandate to adapt the Interactive Domain Model (IDM) to the Franco-Ontarian context. Members include representatives from academic, government and community sectors. What is currently the Public Health Agency of Canada, Ontario and Nunavut Region, provides funding.

Timeline: 2000-2001 The Francophone sub-committee conducts a needs assessment to document the needs of Francophone practitioners and their capacities and interest regarding best practices in health promotion. The Ontario Hospital Health Promotion Network joins the Best Practices Partnership. The first version of the IDM Manual for Best Practices in Health Promotion is produced. The peer-reviewed journal Health Promotion Practice publishes an article explaining IDM Best Practices key concepts. Following a suggestion from one of the original pilot sites, the IDM Computer Program is developed.

Timeline: 2000-2001 continued The Ontario Ministry of Health and Long Term Care funds the development of an IDM “bridging the gap between research and practice” learning module. Six sites participate:  Access Alliance Multicultural CHC (Toronto)  Brant Community HealthCare System (Paris and Brantford)  Peterborough County-City Health Unit  Sudbury and District Health Unit  St. Joseph's Healthcare, Women's Detox and Mary Ellis House Treatment Program (Hamilton)  West Hill Community Health Centre (Toronto) Results are positive.

Timeline: 2002-present The Francophone sub-committee:  adapts and translates into French the IDM Manual and article  develops French-language IDM training modules  conducts three workshops with 30 participants from health and education sectors and community-based groups in Sudbury, Ottawa and Toronto  develops a website An IDM Best Practices Road Map for Coaches and Best Practices Check-In Forms are produced. Groups continue to use the IDM, for example:  The Association des communautés francophone de l'Ontario – Toronto, which has a multi-cultural membership and is volunteer based  Womankind Addiction Service, a new approach to women’s addictions which provides a complete range of services in one place

Timeline: 2002-present continued The IDM continues to influence models and frameworks being developed by other groups, for example:  The IDM was “an insightful resource in developing this Nova Scotia Best Practices Framework.”  “The IDM informed the best practices work we did at the AOHC [Association of Ontario Health Centres], particularly the principles piece.”  “The development of ‘Core Domain #2 - The Underpinnings of Best Practices’ [in a not yet released practice framework] was inspired and influenced significantly by the [IDM].”

Moving into the Future The holistic IDM/MDI, which considers a wide range of decision-making factors  from values and theories to evidence and context  is a usable and effective approach for achieving best practices. The approach is constantly evolving, to reflect users’ needs. IDM tools are helpful at different levels of work, e.g. to ensure that the key elements of health promotion and/or public health are included in a program, to assist in reflection on processes, activities and outcomes, to encourage inclusivity. Providing support to further develop, improve and disseminate IDM/MDI processes and resources will contribute significantly to the achievement of best practices and health promotion/public health goals.

IDM Key concepts Engagement of all key stakeholders Ongoing reflection & improvement Practice based on values, theories, evidence, context MDI Mots-clés Vision commune Engagement Collaboration Flexibilité Perseverance Complémentarité

A few Best Practices Work Group members in front of the Centre for Health Promotion, University of Toronto

IDM Framework (Kahan & Goodstadt, 2001)