Improving Breastfeeding Education of Health Professionals in Québec - The Breastfeeding Committee for ...
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Improving Breastfeeding Education of Health Professionals in Québec Bénédicte Fontaine Bisson, PhD, RD Sonia Blaney, PhD, MSc, RD Isabelle Michaud-Létourneau, PhD, MPH, RD Lucie Hamelin, SF, MA Chantal Doucet, DC, DICCP Julie Robitaille, PhD, RD Mélanie Giard, RN Ema Ferreira, B.Pharm, MSc, PharmD, FSCPH Josée Quesnel, MD, FRCPC Meggie-Anne Roy, MD 2017 Baby-Friendly Initiaitive Félix Girard, DMD, MSc Julie Lauzière, Msc, RD National Symposium Micheline Beaudry, PhD, RD Moncton, Canada Laura Rosa Pascual, MD (Argentina), PhD, IBCLC September 22nd, 2017 Sylvie Chiasson, MA Jacqueline Wassef, MPH, RD 1 Myrtha Traoré, BSc Marion Gayard, MSc, PharmD Catherine Pound, MD, FRCPC
Objectives 1. To outline the situation of BF education of future health professionals in the province of Quebec. 1. To describe strategies carried out to engage key actors from 7 professions to address related challenges province wide (agenda setting). 1. To share future steps to be undertaken by the strategic group.
Plan • CONTEXT • Breastfeeding and enabling environments • Key actors • WHAT HAS BEEN ACHIEVED • Stages 1-2 • GOING FORWARD • Stages 3-4
Status of Breastfeeding Promotion, Protection and Support • Inadequate support leads to physical and psychological negative effects • A large number of mothers state that they did not reach their own breastfeeding goals 5 Source: Amy Bundy (via Flicker)
Global situation – BF indicators 6 UNICEF, From the first hour of life – Making the case for improved infant and young child feeding everywhere, 2016, p.25
Rate of total BF & exclusive BF in Quebec by infant’s age % 90 80 70 Whereas 85 % of mothers 60 breastfeed at discharge (infant is ≈ 2 days old) 50 40 Only 50 % exclusively breastfeed !!! 30 20 10 0 At 1 week 1 month 2 months 3 months 4 months 5 months 6 months discharge 7 Adapted from Neill et al.: Recueil statistique sur l’allaitement maternel au Québec, 2005-2006, Québec, Institut de la statistique du Québec
8 UNICEF, From the first hour of life – Making the case for improved infant and young child feeding everywhere, 2016, p.19
Factors associated with breastfeeding Mother’s Breastfeeding Possibility of turning decisions practices decisions into actions Individual Mother’s attributes Infant’s attributes level factors Attributes of the mother-child dyad Characteristics of the environments Community Public Family Workplaces Virtual organizations transportation setting Group level Childcare settings spaces factors Education Restaurants Health and social Health network Municipal settings services professionals Public policies Commercial settings Societal, cultural and economic attributes Society Family, medical and cultural attitudes and norms level Demographic and economic conditions factors Commercial pressures 9 National and international policies and standards (Lauzière, 2015; adapted from Hector et al., 2005, Lutter, 2000, & Lauzière, 2010)
Working Upstream Cégeps (Colleges), universities Health professionals 10
Who we are? 11
Quebec Breastfeeding Movement • Founded in April 2009 Mission • Promote enabling environments for breastfeeding • Optimal development of young children and well- being of women, families and society • Respect of all women and all families • Independent consultation forum for members (interested individuals and organizations) 12
MAQ Committee on Training (CoT) • Created in November 2010 Mandate • Ensure harmonization of minimum competencies in breastfeeding of all health professionals in the province • through the basic content of their academic curriculum 13
CoT and Strategic Group for breastfeeding education of health professionals (FAPS – in French) • Members’ affiliation and expertise: • Academic, health professionals, community • 7 health professions • Primarily from Québec City, Sherbrooke, Montréal, Trois- Rivières Strategic Group CoT (17 members) (9 members)
We seek to influence actors • Actors involved in the curricula and training of the 7 health professions in Québec cégeps (colleges) and universities (dentists, dietitians, medical doctors, pharmacists, nurses, midwives, chiropractors) • Program professors and lecturers • Program administrators and directors • Students • Regulatory bodies of the 7 health professions • Québec Ministry of Health and Social Services • Québec Ministry of Education • Québec National Institute of Public Health • Partners from academic institutions of other provinces • MAQ’s partner organizations • In addition to MAQ members and other MAQ committees 15
What has been achieved? so far… - Initiative of 4 stages - 16
Stage 1 RESULTS Stage 1: Assessing BF training 2010-11 2013-15 2015-16 2017… 2020 PROCESSES
Survey Urgent need to address the gaps in training of health Dentists, nurses, medical doctors, registered dietitians, professionals on breastfeeding pharmacists, midwives because it may take 5-10 years before changes are in place! 18
Stage 2 RESULTS Stage 2: Agenda setting and engaging key actors Stage 1: Assessing BF training 2010-11 2013-15 2015-16 2017… 2020 PROCESSES
Newsletters • 8 newsletters distributed since november 2014 • 189 subscribers representing 7 health professions (professors and lecturers, directors and responsibles, others) • From 115As in november of today,2014 the to MAQ189 in december has 2016 gathered • Diverse topics:more than 180 professors and • Work of the program CoT (presentations, funding search, administrators acrossetc) • InformationQuébec on breastfeeding and breastfeeding who showed interest ortraining (public statements, recommendations, publications, future conferences, engagement etc.) • High opening rate = The topic resonates with subscribers 20
Focus Groups • Participants from 4 universities in 2 provinces: professors, program managers and students • Research objectives: • Identify the main concerns of the professors and program directors with respect to changes in their programs • Identify the barriers to program changes • Identify enabling factors and potential solutions • Content analysis: 5 emergent themes • Interprofessionalism • Course content • Clinical practice • Counseling • Attitudes 21
Strategic Workshop AVRIL 2016 QUAND ? Vendredi 29 avril 2016 STRATEGIC PLANNING WORKSHOP COLLOQUE DE PLANIFICATION STRATÉGIQUE POUR LA FORMATION DES FOR HEALTH PROFESSIONALS’ PROFESSIONNELS DE LA SANTÉ EN OÙ ? MATIÈRE D’ALLAITEMENT AU QUÉBEC Université de Sherbrooke, INITIAL TRAINING ON BF campus de Longueuil QUI EST ATTENDU ? Les professeurs, enseignants et responsables des programmes de formation des professionnels de la santé dans les universités et cégeps du Québec : médecins, infirmières, nutritionnistes, sages-femmes, dentistes, pharmaciens. P {Source: Mouvement allaitement du Québec} POURQUOI ? Depuis plusieurs années, de nombreux acteurs et organismes locaux et Contribuer à améliorer les programmes de formation globaux (y compris l’OMS et l’UNICEF) dénoncent le manque de des professionnels de la formation des professionnels de la santé en matière d’allaitement. Ce santé en matière Objectives manque de formation a nécessairement des répercussions sur les expériences d’allaitement des femmes en raison du peu de cohérence dans les messages qu’elles reçoivent et de l’insuffisance de soutien d’allaitement, au bénéfice des familles. • Bring people together to think about the curriculum & concret et approprié. Cette situation contribue aux faibles taux d’adhésion aux recommandations en vigueur sur l’allaitement. Par training of future health professionals exemple, en 2005-2006, alors qu’environ 85% des mères québécoises amorçaient l’allaitement à la naissance de leur bébé, seule la moitié MOUVEMENT ALLAITEMENT DU QUÉBEC • Improve the understanding of the challenges d’entre elles l’allaitaient de façon exclusive à leur sortie du lieu de naissance – environ deux jours plus tard. Mais le plus important est que ______ www.AllaiterAuQuebec.org cela se produit souvent à l’encontre de leur objectif initial. Ainsi, de universities & colleges are faced with meilleures pratiques professionnelles pourraient éviter aux mères des info@AllaiterAuQuebec.org • souffrances physiques et psychologiques inutiles. Depuis 2012, les Develop a strategic plan of action to improve the BF critères d’Agrément Canada pour les hôpitaux comprennent d’ailleurs SUIVEZ-NOUS ! @MAQ_Infos 22 plusieurs éléments de l’Initiative Amis des Bébés (IAB). curriculum & training
Participants (48) Regions Professions Organizations • Capitale-Nationale • Chiropractors • Colleges (Cégeps) • Estrie • Lactation Consultants • Universities (Québec and • Laval • Dentists 2 other provinces) • Mauricie • Nurses • Professional Orders • Others: Ministry of Health and • Montérégie • Medical doctors Social Services, Health services • Montréal • Nutritionists network and clinical settings • Outaouais • Pharmacists • MAQ • + Ottawa (Ontario) • Midwives • + Moncton (NB) • Assistant deans, program directors • Professors, teachers, lecturers, practicum coordinators • Students Functions • Delegates of Regulatory bodies and other establishments 23 • Practicing professionals – others • Volunteers
Theatre Play 24 Mauvais Départ (A Bad Start) – Théâtre Parminou, Québec April 29, 2016 - Strategic planning workshop for health professionals’ initial training on BF
Strategic Workshop Outcomes • Drafts of strategic action plans • Increase in participants’ awareness and commitment • Creation of a strategic group of key actors (17 participants – 7 health professions, 9 educational institutions and 2 regulatory bodies) • Priority setting with respect to actions to be carried out (the development of a competency framework) 25
Facilitators and Barriers to Agenda Setting FACILITATORS BARRIERS • Strong established • Funding partnerships • Maintaining • Research projects participants’ interest • Precedent: Successful • Engaging decision- education transformation makers model in Quebec - recently applied to clinical practices training with the elderly • Strategic Workshop • Champion 26
Stage 3 RESULTS Stage 3: Reaching consensus on a common agenda, transversal BF objectives, and shared indicators and measurements Stage 2: Agenda setting and engaging key actors Stage 1: Assessing BF training 2010-11 2013-15 2015-16 2017… 2020 PROCESSES
Common Agenda - Priority Actions • Obtain funding • Staff to support the initiative in 3 provinces • Gradual changes in curricula of health programs • From the objectives of ABM and USBC • Build eventually a competency framework • Develop advocacy tools • For decision-makers unfamiliar with the issue • Create cohesion among members of the strategic group and develop a common understanding of the problem • Example of activity: Visit of hospital designated Baby-friendly • Measure progress on ongoing actions • Strengthen the action plan • Communicate with program administrators to inform them of the 28 initiative
Going Forward 29
Stage 4 RESULTS Stage 4: Carrying out a Collective Impact initiative to improve BF curricula in the initial training of health professionals from 7 professions in 3 provinces Stage 3: Reaching consensus on a common agenda, transversal BF objectives, and shared indicators and measurements Stage 2: Agenda setting and engaging key actors Stage 1: Assessing BF training 2010-11 2013-15 2015-16 2017… 2020 PROCESSES
Framing the next steps as a Collective Impact Initiative • Frame the next steps as a Collective Impact Initiative • Articulated by a team of researchers who have studied successful collective efforts around the globe • Five conditions for a Collective Impact Initiative: • Common agenda • Shared measurement • Mutually reinforcing activities • Continuous collaboration • Backbone support 31
Collective Impact Approach Condition Definition Common agenda All participants share a vision for change that includes a common understanding of the problem and a joint approach to solving the problem through agreed-upon actions. Shared measurement All participating organizations agree on the ways success will be measured and reported, with a short list of common indicators identified. Mutually reinforcing A diverse set of stakeholders, typically across sectors, coordinate a set activities of differentiated activities through a mutually reinforcing plan of action. Continuous All players engage in frequent and structured open communication communication to build trust, assure mutual objectives, and create common motivation. Backbone support An independently funded staff dedicated to the initiative provides ongoing support by guiding the initiative’s vision and strategy, supporting aligned activities, establishing shared measurement practices, building public will, advancing policy, and mobilizing 32 resources. Source: Kania, J. and M. Kramer, Embracing emergence: How collective impact addresses complexity., January, 2013. 21.
Legend Academic institutions Collective Impact initiative Practitioners-clinicians Quebec Other key partners Setting the Initiative - QC
Legend Academic institutions Collective Impact initiative Practitioners-clinicians Quebec Other key partners Setting the Initiative - QC Ontario N-B Setting the initiative – with other provinces Others interested in joining the initiative?
Legend Academic institutions Collective Impact initiative Practitioners-clinicians Quebec Other key partners Setting the Initiative - QC Ontario N-B Setting the initiative – with other provinces Others interested in joining the initiative? Isabelle Michaud-Létourneau: im225@cornell.edu
Stages and actions leading to a Collective Impact Initiative • Enhanced BF competencies in health centers and hospitals RESULTS • Enhanced BF knowledge, attitudes and practices in initial training Stage 4: Carrying out a Collective Impact initiative to improve BF • Curricula changes in 3 provinces curricula in the initial training of health professionals from 6 professions in 3 provinces • Strategic planning workshop (Qc) • Identify barriers and enablers to Stage 3: Reaching consensus on a common agenda, curricula changes • Agree on minimal BF objectives transversal BF objectives, and shared indicators • Develop a targeted BF curriculum and measurements for pediatric residents Stage 2: Agenda setting and engaging • Planning a national BF educational intervention for medical residents key actors in universities, colleges and • Get funding for a strategic professional associations workshop in Québec Identification of: Stage 1: Assessing • BF trainings gaps in 6 health BF training and professions in Qc consulting • Potential deficits in BF knowledge PROCESSES & attitudes of Canadian physicians stakeholders 2010-11 2013-15 2015-16 2017 … 2020 • Creation of core • Newsletters (6) to • Creation of a • Launch in 2 provinces group of strategic engage with key research project • Working groups in 3 provinces, actors actors (professors) • Focus groups to develop strategies • Surveys of • Proposal writing to engage actors • Knowledge brokers to monitor pediatricians and get funding for • Delphi survey to actions and create synergy family doctors in workshop consult and engage • Create a global forum of Canada • Increased experts exchange between actors • Surveys of 6 health communication • Strategic workshop • Monitor progress in policy professions in between MAQ and (launch) in Qc to processes Québec (Qc) researchers reach consensus • Develop doctoral projects
Acknowledgments We would like to acknowledge the generous contribution of the CIHR and the MSSS for their funding, and the support of the Université de Sherbrooke to the CoT in holding the strategic workshop Several anonymous donors have also contributed to this event through a crowdfunding campaign and we thank them warmly. 37
THANK YOU 38
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