Health promotion program implementation, a socio-technical networking process : a case study of a school-based nutrition intervention

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School Social Fragmentation, Economic Deprivation and Social Cohesion and Adolescent Physical Inactivity: A Longitudinal Study

Objectives: To examine the independent influence of school economic deprivation, social fragmentation, and social cohesion on the likelihood of participating in no physical activity among students. Methods: Data are from a large-scale longitudinal study of schools based in disadvantaged communities in Quebec, Canada. Questionnaires were administered every year between 2002 and 2008 among n = 14,924 students aged 12 to 18 from a sample of 70 schools. Cross-sectional and longitudinal analyses were conducted. Multilevel modeling was utilized to account for the clustering of students within schools. Schools were categorized as being low, moderate or high economic deprivation, social fragmentation and social cohesion. Those who indicated that they do no participate in any physical activity during the week were identified as being physically inactive. Results: In baseline multilevel cross-sectional analyses, adolescents attending schools in the highest (compared to the lowest) levels of socioeconomic deprivation and social fragmentation were more likely to be physically inactive (OR = 1.33, 95% CI = 1.03, 1.72; and OR = 1.24, 95% CI = 0.98, 1.56, respectively). Conversely, students attending schools with the highest cohesion were less likely to be physically inactive (OR = 0.78, 95% CI = 0.61, 0.99). In longitudinal analysis, physically active students who attended schools with the highest social fragmentation were more likely to become physically inactive over two years (OR = 1.65, 95% CI = 1.09, 2.51). Conclusion: The school socioeconomic environment appears to be an important contextual influence on participation in no physical activity among adolescents. Following adolescents beyond two years is necessary to determine if these environments have a lasting effect on physical activity behavior

Geographic Variability in the Association between Socioeconomic Status and BMI in the USA and Canada

Objective: Reported associations between socioeconomic status (SES) and obesity are inconsistent depending on gender and geographic location. Globally, these inconsistent observations may hide a variation in the contextual effect on individuals' risk of obesity for subgroups of the population. This study explored the regional variability in the association between SES and BMI in the USA and in Canada, and describes the geographical variance patterns by SES category. Methods: The 2009–2010 samples of the Behavioral Risk Factor Surveillance System (BRFSS) and the Canadian Community Health Survey (CCHS) were used for this comparison study. Three-level random intercept and differential variance multilevel models were built separately for women and men to assess region-specific BMI by SES category and their variance bounds. Results: Associations between individual SES and BMI differed importantly by gender and countries. At the regional-level, the mean BMI variation was significantly different between SES categories in the USA, but not in Canada. In the USA, whereas the county-specific mean BMI of higher SES individuals remained close to the mean, its variation grown as SES decreased. At the county level, variation of mean BMI around the regional mean was 5 kg/m2 in the high SES group, and reached 8.8 kg/m2 in the low SES group. Conclusions: This study underlines how BMI varies by country, region, gender and SES. Lower socioeconomic groups within some regions show a much higher variation in BMI than in other regions. Above the BMI regional mean, important variation patterns of BMI by SES and place of residence were found in the USA. No such pattern was found in Canada. This study suggests that a change in the mean does not necessarily reflect the change in the variance. Analyzing the variance by SES may be a good way to detect subtle influences of social forces underlying social inequalities

Sugar Sweetened Beverage Consumption among Primary School Students: Influence of the Schools’ Vicinity

The purpose of the research was to explore the associations between the characteristics of schools’ vicinity and the risk of sugar sweetened beverage (SSB) consumption in elementary students. Findings exposed an important variation in student’s SSB consumption between schools. Schools with a lower socioeconomic status or in a densely built environment tend to have higher proportion of regular SSB drinkers. These characteristics of the school’s vicinity partly explained the variation observed between them. We estimated that a student moving to a school with a higher proportion of SSB drinkers may increase his/her chances by 52% of becoming a daily consumer. Important changes in dietary preferences can occur when children are in contact with a new social environment. Findings also support the idea that dietary behaviors among children result from the complex interactions between biological, social, and environmental factors

Use of relevailles : relevailles and intersectoral collaborations : brief report.

In the interest of population-based responsibility, health and social services establishments (HSSEs) are expected to establish more working partnerships with organismes communautaires Famille (OCF – community-based family organizations). Some OCFs offer a service called ‘relevailles,’ which consists of providing a home-visiting postnatal support program that adapts to the needs of each family, in order to listen, encourage, inform, and support day-to-day organization. The use and impacts of this service, as well as the collaborations surrounding its implementation in local networks of services provided by health and social services establishments, remain largely unknown

Evaluation of intersectoral collaborations : "Relevailles" and intersectoral collaborations. Brief Report.

HIGHLIGHTS • In 3 of the 4 cases, the key actor in the collaborative network was the OCF coordinator/liaison officer. • All the networks were vulnerable to the departure of a key actor. • Collaborative networks did not include any perinatal assistants. • 35 of the 37 HSSE actors involved in collaborative networks belonged to a local community services centre (CLSC), even when there was a birthing hospital or birthing centre in the HSSE. • Five determinants contributed to or constrained intersectoral collaborations between OCFs and HSSEs. • Sufficiency of resources, knowledge of the partner organization, and complementarity/flexibility in the delivery of services were determinants of collaborations. • Six modes of OCF/HSSE collaboration were identified. • There are few formal mechanisms for collaboration between organizations. • Disagreements/misunderstandings on the mechanisms for sharing information about families occurred between organizations and even within organizations. • Some parents perceived links between OCFs and CLSCs as falling into two modes of collaboration, namely 1) activating the request/recourse to partner organization services and 2) coordinating the services provided to families

Évaluation des collaborations intersectorielles : relevailles et collaborations intersectorielles : rapport bref.

Dans une optique de responsabilité populationnelle, les établissements de santé et de services sociaux (ÉSSS) sont appelés à travailler davantage en partenariat avec les organismes communautaires Famille (OCF). Certains OCF offrent un service de relevailles qui consiste à offrir un soutien postnatal à domicile qui s’adapte aux besoins de chaque famille, afin d’écouter, d’encourager, d’informer et de soutenir l’organisation du quotidien. L’utilisation et les impacts de ce service demeurent largement méconnus, de même que les collaborations entourant sa mise en œuvre à même les réseaux locaux de services des établissements de santé et de services sociaux

Utilisation des relevailles : relevailles et collaborations intersectorielles : rapport bref

Dans une optique de responsabilité populationnelle, les établissements de santé et de services sociaux (ÉSSS) sont appelés à travailler davantage en partenariat avec les organismes communautaires Famille (OCF). Certains OCF offrent un service de relevailles qui consiste à offrir un soutien postnatal à domicile qui s’adapte aux besoins de chaque famille, afin d’écouter, d’encourager, d’informer et de soutenir l’organisation du quotidien. L’utilisation et les impacts de ce service demeurent largement méconnus, de même que les collaborations entourant sa mise en œuvre à même les réseaux locaux de services des établissements de santé et de services sociaux. BUT ET OBJECTIFS But : Évaluer les services de relevailles offerts par quatre OCF et les collaborations intersectorielles qu’ils partagent avec les ÉSSS en vue de consolider les services en période postnatale. Objectifs spécifiques : 1) Évaluer le profil d’utilisation des relevailles offertes par les OCF en termes de continuité, de productivité et de globalité; 2) Explorer les variations d’utilisation des relevailles en fonction des caractéristiques organisationnelles des OCF, des caractéristiques des familles utilisatrices et des besoins exprimés lors de l’inscription aux relevailles. FAITS SAILLANTS • Les OCF desservent une clientèle aux statuts socio-économiques variés présentant principalement des besoins de répit et de soutien pour s’occuper du bébé. Notons que 64 % ont plus d’un enfant, que l’âge moyen du bébé à l’inscription est de 3,6 mois et que 46 % des parents sont informés du service par un professionnel de la santé. • La classification des activités de relevailles en 4 profils permet de situer la spécificité du service et la globalité des tâches réalisées à domicile par les assistantes périnatales. Cela ouvre à une meilleure complémentarité avec le secteur de la santé. • En moyenne, il y a 89 jours entre la première et la dernière visite de relevailles avec un nombre moyen de 9,2 visites par famille. La continuité relationnelle très élevée est un atout pour le développement de liens de confiance. • Malgré un nombre limité d’assistantes périnatales par OCF, la productivité ramenée au plan de la famille se situe autour de 4 visites par mois. • L’utilisation des relevailles est principalement associée aux caractéristiques, prises individuellement, des organisations et à celles des familles. Aucune des variables étudiées ne permet de prédire l’utilisation des relevailles

Retombées auprès des familles utilisatrices : relevailles et collaborations intersectorielles : rapport bref.

Dans une optique de responsabilité populationnelle, les établissements de santé et de services sociaux (ÉSSS) sont appelés à travailler davantage en partenariat avec les organismes communautaires Famille (OCF). Certains OCF offrent un service de relevailles qui consiste à offrir un soutien postnatal à domicile qui s’adapte aux besoins de chaque famille, afin d’écouter, d’encourager, d’informer et de soutenir l’organisation du quotidien. L’utilisation et les impacts de ce service demeurent largement méconnus, de même que les collaborations entourant sa mise en œuvre à même les réseaux locaux de services des établissements de santé et de services sociaux

Chapitre 9. Une exploration de l’interface intervention-environnement

La littérature en évaluation d’implantation ou de mise en œuvre de programmes a depuis longtemps tacitement démontré que les programmes interagissent avec leur environnement. Il n’est pas attendu des programmes que leur mise en œuvre suive les plans définis (Cronbach, 1980 ; Weiss, 1972). De nos jours, l’adaptation est perçue comme partie intégrante de l’implantation. Malgré cette réalité, l’étude de l’adaptation ou de l’« interactivité » environnement-programme est encore aujourd’hui négligé..