Improving Breastfeeding Education of Health Professionals in Québec

1

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

4

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

5

Source: Amy Bundy (via Flicker)

Global situation –BF indicators

6

UNICEF, From the first hour of life – Making the case for improvedinfant and young child feeding everywhere, 2016, p.25

7

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 !!!

8

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)

9

Health professionals

Working Upstream

10

Cégeps (Colleges), universities

Health professionals

11

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)

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

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

16

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

18

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

20

• 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

22

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

info@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

23

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

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

25

• 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

28

• 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

29

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

31

Collective Impact Approach

32

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: im225@cornell.edu

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

37

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.

38

THANK YOU

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 feedingeverywhere, 2016, 104p.https://data.unicef.org/resources/first-hour-life-new-report-breastfeeding-practices/ 40