One program, three modalities of implementation: Analyzing the adaptability of a professional development program in health promotion Marie-Claude Tremblay, PhD Lucie Richard, Sara Torres, Nicole Beaudet, Eric Litvak, François Chiocchio, Julie Des Lauriers

 Professional development = a key component of an effective public health infrastructure.  Professional development programs need to be adapted to different and complex real-world practice settings while preserving the core components of the model being used.  This is articulating the interplay between fidelity and adaptability to a specific context. Context

 This communication aims to present how a public health professional development program, the Health Promotion Laboratory, has been adapted in three different practice settings while preserving its core nature. Objectives

 In 2009, a team from the public health directorate for Montreal (PHDM, Québec) launched an innovative professional development program, the Health Promotion Laboratory.  This intervention aims to support, innovatively and flexibly, multidisciplinary local health centre (CSSS) teams working on particular issues (themes), so that they can design and implement a specific health promotion intervention. Intervention: the Health Promotion Laboratory

 Each HPL is based on a target issue or theme, which is chosen by the participating CSSS.  Each team = approximately ten voluntarily participants.  HPL = Lenghty process involving three-hour meetings every two or three weeks (for two or three years).  Meetings are led by one participant, supported by a mentor from the program promoter agency (PHDM). Intervention: the Health Promotion Laboratory

Steps (core program components) 1) Identify a targeted theme and a team 2) Specify the operational approach 3a)* Acquire basic concepts of public health and provide opportunities for reflection 3b)* Transfer new knowledge and ensure sustainability of the program 4) Study the problem (theme) 5) Identify options for action 6) Develop partnerships 7) Implement a new health promotion action or improve a current intervention Intervention: the Health Promotion Laboratory

 The steps of the operational approach = the program’s core components (which refer to the program’s theory).  How core components are implemented (format and number of activities, sequence of implementation) = the adaptive part of the program. Intervention: the Health Promotion Laboratory

 This implementation analysis is part of a larger multiple case study evaluating the implementation, processes, and outcomes of the Health Promotion Laboratory (Richard et al., 2014).  This study involves three sites (A, B and C) and uses documentary sources of data. Methods

TeamsTheme of the HPLProject developed Lab AOccupational health A health promotion counseling program to support business owners who were either setting up or relocating their operations in the CSSS’s territory. Lab BStudent retentionA health promotion outreach strategy to work with schools to promote the value of education among parents of elementary school children. Lab CChildren experiencing vulnerability Four little intervention projects acting on different factors related to protecting vulnerable children in their territory The cases

Data analysis

 Findings highlight that, owing to their particular contexts, all sites developed a unique and adapted approach to implement differently the core components of the program. Results

Step targetedTeam A N (%) Team B N (%) Team C N (%) 1) Identify a targeted issue and a team 4 (2.4%)2 (1.4%)3 (1.1%) 2) Specify the operational approach 11 (6.6%)12 (8.6%)11 (4.2%) 3a) Acquire basic concepts of public health and provide opportunities for reflection 7 (4.2%)4 (2.9%)10 (3.8%) 3b) Transfer new knowledge and ensure sustainability of the program 69 (41.6%)33 (23.6%)83 (31.8)% 4) Study the problem (theme or targeted issue) 28 (16.9%)29 (20.7%)28 (10.7%) 5) Identify options for action5 (3.0%)28 (20.0%)42 (16.1%) 6) Develop partnerships17 (10.2%)19 (13.6%)37 (14.2%) 7) Implement a new health promotion action or improve a current intervention 25 (15.1%) 13 (9.3%)47 (18.0%) Total 166 (100%) (spanning 29 meetings) 140 (100%) (spanning 40 meetings) 261 (100%) (spanning 56 meetings) Table 1. Percentage of activities devoted to each step

Figure 1. Pattern of implementation - Lab A

Figure 2. Pattern of implementation - Lab B

Figure 3. Pattern of implementation – Lab C

 The findings presented here show that a health promotion professional development program can be successfully tailored to different settings without compromising its core components.  HPL Program allows for :  (1) an initial pre-formatting to accommodate organizational context (theme chosen, team composition, HPL formula);  (2) an ongoing adaptation of implementation to take into account the needs of the participants (nature and number of the activities, patterns of implementation in time) Discussion

 This work highlights the need to make explicit the core elements of a program theory that are critical to achieving the program’s intended outcomes.  It also illustrates the importance of providing flexibility in a program’s design, such that it can be adapted beforehand to different contexts and then on the ground as the implementation unfolds. Conclusion

 For more information on this project, please contact Marie-Claude Tremblay: (research associate) Lucie Richard : (ALPS principal investigator) Nicole Beaudet : (project manager) Thank you!