Marie-Claude Tremblay

Complexity: a potential paradigm for a health promotion discipline

Health promotion underpins a distancing from narrow, simplifying health approaches associated with the biomedical model. However, it has not yet succeeded in formally establishing its theoretical, epistemological and methodological foundations on a single paradigm. The complexity paradigm, which it has yet to broach head-on, might provide it with a disciplinary matrix in line with its implicit stances and basic values. This article seeks to establish complexitys relevance as a paradigm that can contribute to the development of a health promotion discipline. The relevance of complexity is justified primarily by its matching with several implicit epistemological and methodological/theoretical stances found in the cardinal concepts and principles of health promotion. The transcendence of ontological realism and determinism as well as receptiveness in respect of the reflexivity that complexity encompasses are congruent with the values of social justice, participation, empowerment and the concept of positive health that the field promotes. Moreover, from a methodological and theoretical standpoint, complexity assumes a holistic, contextual and transdisciplinary approach, toward which health promotion is tending through its emphasis on ecology and interdisciplinary action. In a quest to illustrate our position, developmental evaluation is presented as an example of practice stemming from a complexity paradigm that can be useful in the evaluation of health promotion initiatives. In short, we argue that it would be advantageous for health promotion to integrate this paradigm, which would provide it with a formal framework appropriate to its purposes and concerns.

Regulation profiles of e-cigarettes in the United States: a critical review with qualitative synthesis

BackgroundElectronic cigarettes (e-cigarettes) have been steadily increasing in popularity since their introduction to US markets in 2007. Debates surrounding the proper regulatory mechanisms needed to mitigate potential harms associated with their use have focused on youth access, their potential for nicotine addiction, and the renormalization of a smoking culture. The objective of this study was to describe the enacted and planned regulations addressing this novel public health concern in the US.MethodsWe searched LexisNexis Academic under Federal Regulations and Registers, as well as State Administrative Codes and Registers. This same database was also used to find information about planned regulations in secondary sources. The search was restricted to US documents produced between January 1st, 2004, and July 14th, 2014.ResultsWe found two planned regulations at the federal level, and 74 enacted and planned regulations in 44 states. We identified six state-based regulation types, including i) access, ii) usage, iii) marketing and advertisement, iv) packaging, v) taxation, and vi) licensure. These were further classified into 10 restriction subtypes: sales, sale to minors, use in indoor public places, use in limited venues, use by minors, licensure, marketing and advertising, packaging, and taxation. Most enacted restrictions aimed primarily to limit youth access, while few regulations enforced comprehensive restrictions on product use and availability.ConclusionsCurrent regulations targeting e-cigarettes in the US are varied in nature and scope. There is greater consensus surrounding youth protection (access by minors and/or use by minors, and/or use in limited venues), with little consensus on multi-level regulations, including comprehensive use bans in public spaces.

Managing Tensions Between Evaluation and Research Illustrative Cases of Developmental Evaluation in the Context of Research

Developmental evaluation (DE), essentially conceptualized by Patton over the past 30 years, is a promising evaluative approach intended to support social innovation and the deployment of complex interventions. Its use is often justified by the complex nature of the interventions being evaluated and the need to produce useful results in real time. Despite its potential advantages, DE appears not to have been very widely used in research. The authors of this article decided to use this emergent approach in two evaluative research projects in health promotion. This article, coming out of their experiences, aims to assess the appropriateness of DE in research and describes issues related to its use. First, DE is presented, along with the potential advantages of its use in research. This is followed by a discussion of tensions related its application encountered in two studies carried out by the authors. The key issues are related to the links between academic and evaluative objectives, the dual role of researcher and consultant, and the temporality of the process. Finally, weighing the advantages of DE against its challenges, the authors conclude with a diagnosis regarding the application of this approach in research.

Defining, illustrating and reflecting on logic analysis with an example from a professional development program

Program designers and evaluators should make a point of testing the validity of a programs intervention theory before investing either in implementation or in any type of evaluation. In this context, logic analysis can be a particularly useful option, since it can be used to test the plausibility of a programs intervention theory using scientific knowledge. Professional development in public health is one field among several that would truly benefit from logic analysis, as it appears to be generally lacking in theorization and evaluation. This article presents the application of this analysis method to an innovative public health professional development program, the Health Promotion Laboratory. More specifically, this paper aims to (1) define the logic analysis approach and differentiate it from similar evaluative methods; (2) illustrate the application of this method by a concrete example (logic analysis of a professional development program); and (3) reflect on the requirements of each phase of logic analysis, as well as on the advantages and disadvantages of such an evaluation method. Using logic analysis to evaluate the Health Promotion Laboratory showed that, generally speaking, the programs intervention theory appeared to have been well designed. By testing and critically discussing logic analysis, this article also contributes to further improving and clarifying the method.

How Can Both the Intervention and Its Evaluation Fulfill Health Promotion Principles? An Example From a Professional Development Program

The emergence over the past 20 years of health promotion discourse poses a specific challenge to public health professionals, who must come to terms with new roles and new intervention strategies. Professional development is, among other things, a lever for action to be emphasized in order to meet these challenges. To respond to the specific training needs of public health professionals, a team from the Direction de santé publique de Montréal (Montreal Public Health Department) in Quebec, Canada, established in 2009 the Health Promotion Laboratory, an innovative professional development project. An evaluative component, which supports the project’s implementation by providing feedback, is also integrated into the project. This article seeks to demonstrate that it is possible to integrate the basic principles of health promotion into a professional development program and its evaluation. To this end, it presents an analytical reading of both the intervention and its evaluation component in light of the cardinal principles in this field. Initiatives such as the Health Promotion Laboratory and its evaluation are essential to consolidate the foundations of professional development and its assessment by concretely integrating health promotion discourse into these practices.

Reflexivity in PHIR: Let's have a reflexive talk!

In 2009, a group of researchers who gathered in the context of the Population Health Intervention Research Initiative for Canada (PHIRIC) agreed upon the need to define a specific set of competencies for population health intervention research (PHIR). Following this event, a consultative process allowed the definition of six domains of core competencies in PHIR, which were released for the first time last summer. In this comment, we would like to respond to this set of competencies and, more specifically, to the “reflective researcher” domain of the competencies. We believe that propositions in this domain are rooted in a narrow and oversimplified definition of reflexivity. Furthermore, we are concerned that disseminating such propositions is not only misleading but could also encourage a false practice of reflexivity, impeding the evolution of the PHIR field and its capacity to improve population health. In order to illustrate our point, we build on commonly accepted definitions of reflexivity to critically examine the initial propositions of the group and suggest new ones. As researchers in the population health intervention field, we believe that a more accurate definition of what is a reflective researcher is crucial in order to foster the continuous development of the field and its capacity to improve population health.RésuméEn 2009, un groupe de chercheurs réunis dans le cadre de l’Initiative de recherche interventionnelle en santé des populations du Canada (IRISPC) a identifié le besoin de définir un ensemble de compétences pour la recherche interventionnelle en santé des populations (RISP). À la suite de cet évènement, un processus consultatif a permis de définir six domaines de compétences essentielles en RISP, qui furent rendus publics pour la première fois l’été dernier (2013). Dans ce commentaire, nous aimerions réagir à cet ensemble de compétences, plus spécifiquement à la catégorie «Être un chercheur réflexif». Nous croyons en effet que les propositions présentées dans cette catégorie sont ancrées dans une définition simpliste et étroite de la réflexivité. Nous sommes non seulement préoccupées par le fait que ces propositions puissent être inexactes, mais également qu’elles puissent encourager une fausse pratique de réflexivité, entravant l’évolution du champ de la RISP et sa capacité à améliorer la santé des populations. De façon à construire notre argumentaire, nous nous appuyons sur des définitions traditionnelles de la réflexivité pour examiner de façon critique les propositions initiales du groupe et en suggérer de nouvelles. En tant que chercheures dans le domaine de la recherche interventionnelle en santé des populations, nous croyons fermement qu’une définition plus exacte de ce que représente un chercheur réflexif est cruciale en vue de promouvoir le développement du champ et sa capacité à améliorer la santé des populations.

An analysis of the adaptability of a professional development program in public health: results from the ALPS Study

BackgroundProfessional development is a key component of effective public health infrastructures. To be successful, professional development programs in public health and health promotion must adapt to practitioners’ complex real-world practice settings while preserving the core components of those programs’ models and theoretical bases. An appropriate balance must be struck between implementation fidelity, defined as respecting the core nature of the program that underlies its effects, and adaptability to context to maximize benefit in specific situations. This article presents a professional development pilot program, the Health Promotion Laboratory (HPL), and analyzes how it was adapted to three different settings while preserving its core components. An exploratory analysis was also conducted to identify team and contextual factors that might have been at play in the emergence of implementation profiles in each site.MethodsThis paper describes the program, its core components and adaptive features, along with three implementation experiences in local public health teams in Quebec, Canada. For each setting, documentary sources were analyzed to trace the implementation of activities, including temporal patterns throughout the project for each program component. Information about teams and their contexts/settings was obtained through documentary analysis and semi-structured interviews with HPL participants, colleagues and managers from each organization.ResultsWhile each team developed a unique pattern of implementing the activities, all the program’s core components were implemented. Differences of implementation were observed in terms of numbers and percentages of activities related to different components of the program as well as in the patterns of activities across time. It is plausible that organizational characteristics influencing, for example, work schedule flexibility or learning culture might have played a role in the HPL implementation process.ConclusionsThis paper shows how a professional development program model can be adapted to different contexts while preserving its core components. Capturing the heterogeneity of the intervention’s exposure, as was done here, will make possible in-depth impact analyses involving, for example, the testing of program–context interactions to identify program outcomes predictors. Such work is essential to advance knowledge on the action mechanisms of professional development programs.

Can we Build on Social Movement Theories to Develop and Improve Community-Based Participatory Research? A Framework Synthesis Review

Abstract A long‐standing challenge in community‐based participatory research (CBPR) has been to anchor practice and evaluation in a relevant and comprehensive theoretical framework of community change. This study describes the development of a multidimensional conceptual framework that builds on social movement theories to identify key components of CBPR processes. Framework synthesis was used as a general literature search and analysis strategy. An initial conceptual framework was developed from the theoretical literature on social movement. A literature search performed to identify illustrative CBPR projects yielded 635 potentially relevant documents, from which eight projects (corresponding to 58 publications) were retained after record and full‐text screening. Framework synthesis was used to code and organize data from these projects, ultimately providing a refined framework. The final conceptual framework maps key concepts of CBPR mobilization processes, such as the pivotal role of the partnership; resources and opportunities as necessary components feeding the partnerships development; the importance of framing processes; and a tight alignment between the cause (partnerships goal), the collective action strategy, and the system changes targeted. The revised framework provides a context‐specific model to generate a new, innovative understanding of CBPR mobilization processes, drawing on existing theoretical foundations.

Une formation complémentaire et appliquée : un besoin pour la relève en recherche interventionnelle en santé des populations

RésuméLa recherche interventionnelle en santé des populations (RISP) est un champ de recherche émergeant et distinct, qui appelle à la rencontre des milieux scientifiques et de pratique de santé publique. Or, la formation académique traditionnelle universitaire, qui repose sur des ancrages disciplinaires spécifiques, est insuffisante pour outiller adéquatement les nouveaux chercheurs en RISP. Dans ce commentaire, nous soutenons l’idée que la RISP nécessite la mise en œuvre d’un éventail de compétences et de connaissances distinctes, qui sont plus aisément acquises et développées à travers une formation complémentaire et appliquée. En nous appuyant sur notre expérience comme boursiers du Programme stratégique de formation 4P, nous avons identifié les éléments qui ont contribué à préparer notre carrière de futurs et nouveaux chercheurs en RISP. Nous croyons que les programmes de formation complémentaires et appliqués, tels que le Programme 4P, représentent une stratégie prometteuse pour former et soutenir la relève en RISP dans son rôle d’amélioration de la santé des populations.AbstractPopulation Health Intervention Research (PHIR) is an emerging and distinct field that combines scientific research and public health practice. However, traditional academic training in research, which is founded on specific disciplinary orientations, does not sufficiently inform and prepare new PHIR researchers. In this commentary, we advance the idea that PHIR requires a broader range of competencies and knowledge that must be developed through a complementary and applied training program. Drawing on our experience as 4P Strategic Training Program fellows, we identified key elements of the program that have helped prepare us in our careers as future and new PHIR researchers. We believe that complementary and applied training programs such as the 4P Program are a promising strategy in training and supporting the next generation of PHIR researchers in their efforts to improve population health.

Understanding community-based participatory research through a social movement framework: a case study of the Kahnawake Schools Diabetes Prevention Project

BackgroundA longstanding challenge of community-based participatory research (CBPR) has been to anchor evaluation and practice in a relevant theoretical framework of community change, which articulates specific and concrete evaluative benchmarks. Social movement theories provide a broad range of theoretical tools to understand and facilitate social change processes, such as those involved in CBPR. Social movement theories have the potential to provide a coherent representation of how mobilization and collective action is gradually developed and leads to systemic change in the context of CBPR. The current study builds on a social movement perspective to assess the processes and intermediate outcomes of a longstanding health promotion CBPR project with an Indigenous community, the Kahnawake Schools Diabetes Prevention Project (KDSPP).MethodsThis research uses a case study design layered on a movement-building evaluation framework, which allows progress to be tracked over time. Data collection strategies included document (scientific and organizational) review (n = 51) and talking circles with four important community stakeholder groups (n = 24).ResultsFindings provide an innovative and chronological perspective of the evolution of KSDPP as seen through a social movement lens, and identify intermediate outcomes associated with different dimensions of movement building achieved by the project over time (mobilization, leadership, vision and frames, alliance and partnerships, as well as advocacy and action strategies). It also points to areas of improvement for KSDPP in building its potential for action.ConclusionWhile this study’s results are directly relevant and applicable to the local context of KSDPP, they also highlight useful lessons and conclusions for the planning and evaluation of other long-standing and sustainable CBPR initiatives. The conceptual framework provides meaningful benchmarks to track evidence of progress in the context of CBPR. Findings from the study offer new ways of thinking about the evaluation of CBPR projects and their progress by drawing on frameworks that guide other forms of collective action.