Improving Breastfeeding Education of Health Professionals in Québec - The Breastfeeding Committee for ...

Page created by Stanley Craig
CONTINUE READING
Improving Breastfeeding Education of Health Professionals in Québec - The Breastfeeding Committee for ...
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
Improving Breastfeeding Education of Health Professionals in Québec - The Breastfeeding Committee for ...
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.
Improving Breastfeeding Education of Health Professionals in Québec - The Breastfeeding Committee for ...
Plan

• CONTEXT
  • Breastfeeding and enabling environments
  • Key actors
• WHAT HAS BEEN ACHIEVED
  • Stages 1-2
• GOING FORWARD
  • Stages 3-4
Improving Breastfeeding Education of Health Professionals in Québec - The Breastfeeding Committee for ...
Context

          4
Improving Breastfeeding Education of Health Professionals in Québec - The Breastfeeding Committee for ...
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
Bibliography (1)
•   Kelly MP : The relationship between evidence and practice: some considerations in breastfeeding.
    Maternal & Child Nutrition 2006, 2: 191-192. http://dx.doi.org/10.1111/j.1740-8709.2006.00076.x
•   Renfrew MJ: Time to get serious about educating health professionals. Maternal & Child Nutrition 2006,
    2: 193-195. http://dx.doi.org/10.1111/j.1740-8709.2006.00075.x
•   Pound CM, Williams K, Grenon R, Aglipay M, Plint AC: Breastfeeding Knowledge, Confidence, Beliefs, and
    Attitudes of Canadian Physicians. Journal of Human Lactation 2014, 30: 298-309.
    http://jhl.sagepub.com/content/early/2014/06/02/0890334414535507.abstract
•   World Health Organization, UNICEF: Baby-Friendly Hospital Initiative - Revised, updated and expanded
    for integrated care. (Nutrition ed. Geneva, Switzerland: World Health Organization; 2009
    http://www.who.int/nutrition/publications/infantfeeding/bfhi_trainingcourse/en/
•   Comité canadien pour l'allaitement, rédigé pour l'Agence de la santé publique du Canada : Initiative amis
    des bébés au Canada - Rapport de situation - Mise à jour 2014. 2014: 65 p.
    http://breastfeedingcanada.ca/documents/Final%202014%20Status%20Report%20FR.pdf
•   Semenic S, Childerhose JE, Lauzière J, Groleau D: Barriers, Facilitators, and Recommendations Related to
    Implementing the Baby-Friendly Initiative (BFI): An Integrative Review. Journal of Human Lactation
    2012, 28: 317-334. http://jhl.sagepub.com/content/28/3/317.abstract (consulté septembre 2016).
•   Series on Breastfeeding. The Lancet 2016, 387: 404; 413-415; 416; 475-490; 491-504.
    http://www.thelancet.com/journals/lancet/issue/vol387no10017/PIIS0140-6736(16)X0005-0
• Comité formation – Mouvement allaitement du Québec. Formation en allaitement des
  professionnelLEs de la santé au Québec. Résultats d’un sondage auprès des responsables de
  programmes de formation de base des professionnelLEs de la santé dans les établissements
  universitaires et collégiaux au Québec (infirmièrEs, médecins, dentistes, nutritionnistes,
  pharmacienNEs, sages-femmes). Avril 2013. 44 p.                                                               39
Bibliography (2)
•   World Health Organization: Infant and young child feeding - Model Chapter for textbooks for medical
    students and allied health professionals. Departments of Child and Adolescent Health and Development
    (CAH) and of Nutrition for Health and Development (NHD), Geneva, 2009. 111 p.
    http://www.who.int/maternal_child_adolescent/documents/9789241597494/en/ (consulté septembre
    2016).
•   American Academy of Pediatrics: Breastfeeding and the Use of Human Milk - Policy Statement.
    Pediatrics 2012, 129: e827-e841. http://pediatrics.aappublications.org/content/129/3/e827 (consulté
    septembre 2016).
•   The Academy of Breastfeeding Medicine: Educational Objectives and Skills for the Physician with
    Respect to Breastfeeding. Breastfeeding Medicine 2011, 6: 99-105.
    http://dx.doi.org/10.1089/bfm.2011.9994
•   Lauzière J, Beaudry M, Chiasson S, Pascual L, Le Roy J, Michaud-Létourneau I, Gaboury I: Portrait de la
    formation en matière d’allaitement dans les programmes de formation qualifiant au droit de pratique
    en santé au Québec. In Journées annuelles de santé publique (JASP). Québec; 2014.
    https://www.inspq.qc.ca/jasp/portrait-de-la-formation-en-matiere-d-allaitement-dans-les-programmes-
    de-formation-qualifiante-en-sante-au-quebec
•   United States Breastfeeding Committee: Core Competencies in Breastfeeding Care and Services for All
    Health Professionals. Rev. edition. Washington, DC: 2010 Rev. ed.:8 p.
    http://www.usbreastfeeding.org/core-competencies (consulté avril 2016).
•   World Health Organization: Infant and young child feeding - Model Chapter for textbooks for medical
    students and allied health professionals. (Departments of Child and Adolescent Health and
    Development (CAH) and of Nutrition for Health and Development (NHD) ed. Geneva: World Health
    Organization; 2009: 111p.
    http://www.who.int/maternal_child_adolescent/documents/9789241597494/en/
•   UNICEF, From the first hour of life – Making the case for improved infant and young child feeding
    everywhere, 2016, 104p.https://data.unicef.org/resources/first-hour-life-new-report-breastfeeding-
    practices/                                                                                                40
You can also read