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Improving Breastfeeding Education of Health Professionals in Québec
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2017 Baby-Friendly InitiaitiveNational Symposium
Moncton, CanadaSeptember 22nd, 2017
Bénédicte Fontaine Bisson, PhD, RD
Sonia Blaney, PhD, MSc, RD
Lucie Hamelin, SF, MA
Julie Robitaille, PhD, RD
Mélanie Giard, RN
Ema Ferreira, B.Pharm, MSc, PharmD, FSCPH
Josée Quesnel, MD, FRCPC
Meggie-Anne Roy, MD
Félix Girard, DMD, MSc
Julie Lauzière, Msc, RD
Micheline Beaudry, PhD, RD
Laura Rosa Pascual, MD (Argentina), PhD, IBCLC
Sylvie Chiasson, MA
Jacqueline Wassef, MPH, RD
Myrtha Traoré, BSc
Marion Gayard, MSc, PharmD
Catherine Pound, MD, FRCPC
Isabelle Michaud-Létourneau, PhD, MPH, RD
Chantal Doucet, DC, DICCP
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
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Context
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
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Source: Amy Bundy (via Flicker)
Global situation –BF indicators
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UNICEF, From the first hour of life – Making the case for improvedinfant and young child feeding everywhere, 2016, p.25
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Adapted from Neill et al.: Recueil statistique sur l’allaitement maternel au Québec, 2005-2006, Québec, Institut de la statistique du Québec
Rate of total BF & exclusive BF in Quebec by infant’s age
%
0
10
20
30
40
50
60
70
80
90
Atdischarge
1 week 1 month 2 months 3 months 4 months 5 months 6 months
Whereas 85 % of mothersbreastfeed at discharge
(infant is ≈ 2 days old)
Only 50 % exclusively breastfeed !!!
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UNICEF, From the first hour of life – Making the case for improvedinfant and young child feeding everywhere, 2016, p.19
Factors associated with breastfeeding
Society level
factors
Societal, cultural and economic attributes Family, medical and cultural attitudes and norms Demographic and economic conditions Commercial pressures National and international policies and standards
Individuallevel
factors Attributes of the mother-child dyad
Infant’s attributesMother’s attributes
Mother’sdecisions
Possibility of turningdecisions into actions
Breastfeedingpractices
Group level factors
Familysetting
Public policies
Characteristics of the environments
Health and social services
Workplaces
Commercial settings
Communityorganizations
Educationnetwork Municipal settings
Childcare settings
Virtual spaces
Public transportation
Restaurants
(Lauzière, 2015; adapted from Hector et al., 2005, Lutter, 2000, & Lauzière, 2010)
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Health professionals
Working Upstream
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Cégeps (Colleges), universities
Health professionals
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Who we are?
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)
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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
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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
CoT(9 members)
Strategic Group(17 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
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What has been achieved?so far…
- Initiative of 4 stages -
Stage 1: Assessing BF training
RESULTS
PROCESSES
2010-11 2013-15 2015-16 2017… 2020
Stage 1
Survey
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Dentists, nurses, medical doctors, registered dietitians, pharmacists, midwives
Urgent need to address the gaps in training of health
professionals on breastfeeding because it may take 5-10 years
before changes are in place!
Stage 2: Agenda setting and engaging key actors
Stage 1: Assessing BF training
RESULTS
PROCESSES
2010-11 2013-15 2015-16 2017… 2020
Stage 2
Newsletters
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• 8 newsletters distributed since november 2014
• 189 subscribers representing 7 health professions (professors and lecturers, directors and responsibles, others)
• From 115 in november 2014 to 189 in december 2016
• Diverse topics:
• Work of the CoT (presentations, funding search, etc)
• Information on breastfeeding and breastfeeding training (public statements, recommendations, publications, future conferences, etc.)
• High opening rate = The topic resonates with subscribers
As of today, the MAQ has gathered more than 180 professors and program administrators across
Québec who showed interest or engagement
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
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AVRIL 2016
COLLOQUE DE PLANIFICATION STRATÉGIQUE POUR LA FORMATION DES PROFESSIONNELS DE LA SANTÉ EN MATIÈRE D’ALLAITEMENT AU QUÉBEC
Depuis plusieurs années, de nombreux acteurs et organismes locaux et
globaux (y compris l’OMS et l’UNICEF) dénoncent le manque de
formation des professionnels de la santé en matière d’allaitement. Ce
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
concret et approprié. Cette situation contribue aux faibles taux
d’adhésion aux recommandations en vigueur sur l’allaitement. Par
exemple, en 2005-2006, alors qu’environ 85% des mères québécoises
amorçaient l’allaitement à la naissance de leur bébé, seule la moitié
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
cela se produit souvent à l’encontre de leur objectif initial. Ainsi, de
meilleures pratiques professionnelles pourraient éviter aux mères des
souffrances physiques et psychologiques inutiles. Depuis 2012, les
critères d’Agrément Canada pour les hôpitaux comprennent d’ailleurs
plusieurs éléments de l’Initiative Amis des Bébés (IAB).
QUAND ?
Vendredi 29 avril 2016
OÙ ?
Université de Sherbrooke,
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
POURQUOI ?
Contribuer à améliorer les
programmes de formation
des professionnels de la
santé en matière
d’allaitement, au bénéfice des
familles.
MOUVEMENT
ALLAITEMENT DU QUÉBEC
______
www.AllaiterAuQuebec.org
SUIVEZ-NOUS ! @MAQ_Infos
{Source: Mouvement allaitement du Québec}
STRATEGIC PLANNING WORKSHOP FOR HEALTH PROFESSIONALS’ INITIAL TRAINING ON BF
Objectives• Bring people together to think about the curriculum &
training of future health professionals• Improve the understanding of the challenges
universities & colleges are faced with • Develop a strategic plan of action to improve the BF
curriculum & training
Participants (48)
Professions• Chiropractors
• Lactation Consultants
• Dentists
• Nurses
• Medical doctors
• Nutritionists
• Pharmacists
• Midwives
Organizations
• Colleges (Cégeps)
• Universities (Québec and 2 other provinces)
• Professional Orders
• Others: Ministry of Health and Social Services, Health services network and clinical settings
• MAQ
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Regions
• Capitale-Nationale
• Estrie
• Laval
• Mauricie
• Montérégie
• Montréal
• Outaouais
• + Ottawa (Ontario)
• + Moncton (NB)
Functions
• Assistant deans, program directors
• Professors, teachers, lecturers, practicum coordinators
• Students
• Delegates of Regulatory bodies and other establishments
• Practicing professionals – others
• Volunteers
Theatre Play
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Mauvais Départ (A Bad Start) – Théâtre Parminou, Québec April 29, 2016 - Strategic planning workshop for health professionals’ initial training on BF
Strategic Workshop Outcomes
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• 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)
Facilitators and Barriers to Agenda Setting
FACILITATORS
• Strong established partnerships
• Research projects
• Precedent: Successful
education transformation model in Quebec - recently applied to clinical practices training with the elderly
• Strategic Workshop
• Champion26
• Funding
• Maintaining participants’ interest
• Engaging decision-makers
BARRIERS
Stage 3: Reaching consensus on a common agenda, transversal BF objectives, and shared indicators and measurements
Stage 1: Assessing BF training
RESULTS
PROCESSES
2010-11 2013-15 2015-16 2017… 2020
Stage 3
Stage 2: Agenda setting and engaging key actors
Common Agenda - Priority Actions
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• 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 initiative
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Going Forward
Stage 3: Reaching consensus on a common agenda, transversal BF objectives, and shared indicators and measurements
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 1: Assessing BF training
RESULTS
PROCESSES
2010-11 2013-15 2015-16 2017… 2020
Stage 4
Stage 2: Agenda setting and engaging key actors
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
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Collective Impact Approach
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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 activities
A diverse set of stakeholders, typically across sectors, coordinate a set of differentiated activities through a mutually reinforcing plan of action.
Continuous communication
All players engage in frequent and structured open 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 resources.
Source: Kania, J. and M. Kramer, Embracing emergence: How collective impact addresses complexity., January, 2013. 21.
Legend
Academic institutions
Practitioners-clinicians
Other key partners
Setting the Initiative - QC
Quebec
Collective Impact initiative
Legend
Academic institutions
Practitioners-clinicians
Other key partners
Setting theinitiative –with other provinces
Setting the Initiative - QC
Quebec
Ontario N-B
Others interested in joining the initiative?
Collective Impact initiative
Legend
Academic institutions
Practitioners-clinicians
Other key partners
Setting theinitiative –with other provinces
Setting the Initiative - QC
Quebec
Ontario N-B
Others interested in joining the initiative?
Collective Impact initiative
Isabelle Michaud-Létourneau: [email protected]
Stage 1: Assessing BF training and consulting stakeholders
Stage 2: Agenda setting and engaging key actors in universities, colleges and professional associations
Stage 3: Reaching consensus on a common agenda, transversal BF objectives, and shared indicators and measurements
Stage 4: Carrying out a Collective Impact initiative to improve BF curricula in the initial training of health professionals from 6 professions in 3 provinces
RESULTS
PROCESSES
Identification of:• BF trainings gaps in 6 health
professions in Qc • Potential deficits in BF knowledge
& attitudes of Canadian physicians
• Planning a national BF educational intervention for medical residents
• Get funding for a strategic workshop in Québec
Stages and actions leading to a Collective Impact Initiative
• Strategic planning workshop (Qc)• Identify barriers and enablers to
curricula changes• Agree on minimal BF objectives• Develop a targeted BF curriculum
for pediatric residents
• Enhanced BF competencies in health centers and hospitals
• Enhanced BF knowledge, attitudes and practices in initial training
• Curricula changes in 3 provinces
2010-11• Creation of core
group of strategic actors
• Surveys of pediatricians and family doctors in Canada
• Surveys of 6 health professions in Québec (Qc)
• Newsletters (6) to engage with key actors (professors)
• Proposal writing to get funding for workshop
• Increased communication between MAQ and researchers
2013-15 2015-16• Creation of a
research project• Focus groups to
engage actors• Delphi survey to
consult and engage experts
• Strategic workshop (launch) in Qc to reach consensus
• Launch in 2 provinces• Working groups in 3 provinces,
develop strategies• Knowledge brokers to monitor
actions and create synergy • Create a global forum of
exchange between actors• Monitor progress in policy
processes• Develop doctoral projects
2017 … 2020
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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
Acknowledgments
Several anonymous donors have also contributed to this event through a crowdfunding campaign and we thank them warmly.
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THANK YOU
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