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Pilot Implementation Process Print E-mail

The pilot test team

The reproductive health team consisted of seven-members including the supervisor and one placement student. Except for the students, all participants had been working for OPH between 3 and 30 years and on the specific team between 6-months and 28 years. A member of the health unit's evaluation department also participated during all team meetings. Her role was to introduce the MIP Tool Kit, explain the pilot process and serve as a consultant.

The pilot sessions

The team reserved 1.5 hours of their regular 3-hour team meetings to pilot test the tool. The team met on a bi-weekly basis. The pilot was implemented between January and March 2009 during five sessions. A laptop linked to the internet was used during all sessions, allowing access to the MIP Tool Kit website including its links. The laptop was connected to a projector which enlarged the computer screen and projected it on to the wall of the meeting room.

Session 1 - Focus: Introducing the MIP Tool Kit and the OPHS

The staff from the evaluation department provided an overview of the MIP Tool Kit website, using the laptop computer and its enhanced screening feature, so that all participants were able to view the screen. Participants explored and got accustomed to the navigation features and different sections of the website (modules, examples, activities, glossary). One team member took on the role of navigating the website, frequently directed by her colleagues (e.g., "click on the glossary to find a definition for what they mean by ‘socio-ecological assessment'!" "Go to the link for the population health institute!").

The program supervisor introduced the new Ontario Public Health Standards (OPHS) and read selected passages aloud that applied to the work of the reproductive health team (Family Health Program Standards, Reproductive Health, p. 25). Terms used in the OPHS were compared to those used on the website.

For example, the steps involved in conducting a "socio-ecological assessment" were compared to those required in the Standards that included conducting a "situational assessment" (Population Health Assessment and Surveillance Protocol, 2008, p. 8; and glossary with definition*). Participants concluded that the terms almost could be used interchangeably, because most of the steps were identical.

The team reviewed Module 1 step-by-step, reading and discussing the content and considering each question. They reviewed most of the highlighted boxes designed to provide more background information.

Team members suggested a number of additional links that they would find useful, e.g., to health-evidence.ca website; other Ontario Ministries to ensure that broader determinants of health are considered, such as Ministry of Children and Youth Services, Ministry of Labour; Ontario Health Promotion Resource System; Ontario Prevention Clearinghouse (now called NEXUS); and to make reference to the assessment tool that they are required to complete at their Health Unit prior to implementing a new program (HADD). Another suggestion was to include elements of the SWOT analysis which most planners are familiar with. Inclusion of this type of assessment would be useful during the initial planning and decision making process about the program focus.

At the end of the session, team members were encouraged to explore the website individually and monitor their own use (specific template was circulated to each member). They were also asked to consider which of two possible programs that the team was planning to implement should be applied during the pilot planning process.

Session 2 - Focus: Deciding if the program focus is suitable for a conducting a MIP

Prior to the 2nd session the team decided to focus the MIP Tool Kit pilot on adapting the pregnancy circle program. The program was to be implemented in collaboration with one of the local Community Health Centres (CHCs) starting in the upcoming week. One of the team members was the lead public health nurse who was in charge of implementing the program. She was going to work together with her placement student.

The supervisor provided background information about the target community and passed out the ‘neighbourhood profiles' for this specific area. Health status factors were compared to the overall population of the city, including statistics about hospital visitation, low birth weight, and pre-term babies. Other social determinants of health also were compared (income).

Situational assessment: A situational assessment influences planning in significant ways by examining the legal and political environment, stakeholders, the health needs of the population, the literature and previous evaluations, as well as the overall vision for the project. The phrase "situational assessment" is now used rather than the previous term "needs assessment." This\ is intentional. The new terminology is used as a way to avoid the common pitfall of only looking at problems and difficulties. Instead it encourages considering the strengths of and opportunities for individuals and communities. In a health promotion context, this also means looking at socio-environmental conditions and broader determinants of health." (Health Communication Unit, 2006).

The HU evaluation staff provided hard copies of all the MIP Tool Kit activities. The focus of this session became the completion of the Introductory Activity template. Each question was discussed in detail and team members provided information based on their experiences and knowledge.

The team concluded that the planned intervention was more than a single intervention, because:

  • The issue that was being addressed was in line with the OPHS to reduce low birth weights ["Societal outcome: An increased proportion of full-term newborns are born within a healthy birth weight range." (OPHS, p. 25)]. The specific target community had higher than average low birth rates. In addition, the program target, immigrant women, was one of the vulnerable population groups ("Board of Health Outcomes: Priority populations are linked to reproductive health information, programs and services" (OPHS, p.25). Reducing low birth weights as an outcome was going to be achieved through providing education on nutrition, physical activity, prenatal information, and tobacco interventions
  • The specific intervention, pregnancy circle, was implemented in another neighbourhood in the city; there was potential to expand the program and use it as an approach that could be implemented citywide
  • The program was more than a single intervention, because the PHN was going to work with the staff at the CHC as liaison which would be working at a different level, following the OPHS principles of partnership and collaboration
  • Different strategies would be needed to address the different levels
  • When the program was implemented in another community in the city, a number of other partners became involved with the program. As a result different relationships were formed with these organizations

Sessions 3 - 5 Focus: Conducting a socio-ecological assessment

The following three sessions can be described as a combination of collecting information to populate the Module 1 Activity 1 template and monitoring the program implementation process. The team had decided which intervention to implement. The program had already started and participants had been recruited. As a result, most information included in the socio-ecological assessment could be considered as assisting in the program monitoring process, rather than exclusively serving as a planning tool for a multiple intervention program.

At the beginning of Session 3, the completed hardcopy of the MIP Tool Kit Introductory Activity was circulated to all team members for review. During the session, the Module 1 activity template was used in electronic format, using the laptop computer and projector. The team supervisor completed sections and information to answer questions according to input from the team on-line.

The characteristics of the target group were discussed in detail. In addition, the information needs that pregnancy circle program participants had articulated, and the program elements that had been implemented were presented. Team members contributed ideas and insights from their own experience working with similar community groups. Knowledge gaps about immigration to Canada, current immigration levels from specific source countries, and characteristics of immigrants were identified. One of the participants offered to look into providing more information on these issues during the next session.

Session 4

The team continued to conduct a socio-ecological assessment by completing the Module 1 Activity template, applying a similar process to the one used during Session 3. The lead team member presented more information about the participants based on program intake forms, e.g., education level, smoking scores, Larson scores.

The team consulted the following additional data sources:

  • Results from the Early Development Inventory (EDI) were compiled for the specific area, indicating low school readiness scores in the area as compared to Ottawa as a whole. The EDI assesses children's school readiness in 5 domains (physical health and weel-being, social competence, emotional maturity, language and cognitive development, communication skills and general knowledge.It is a population based tool and provides local, provincial and national comparison data.
  • Facts and Figures 2007 - Citizenship and Immigration
  1. Number of refugees in the city was examined, particularly from a specific source country, and found to be appropriate for programming.
  2. Level of education of newcomers was seen to be high, including for women.
  3. Majority of immigrant women were in child bearing years:
  4. age 25-44.
  5. Language knowledge: half speak English (Level of French language knowledge was not discussed).
  6. Figures were compared to the pregnancy circle participants attending the group, concluding that participants seem to be reflective of the overall refugee population from the specific source country.
  • Social determinants of health were reviewed and discussed based on the specific knowledge that was available about the pregnancy circle participants.

Question 5 in the socio-ecological assessment requires linking the determinants of health. Team members were unsure of how to undertake this task, given that the template did not allow them to regroup or link the text very well.

Session 5

Between team meetings, the supervisor had met with the lead team member in charge of implementing the pregnancy circle program, to complete the last items of the socio-ecological assessment template. The completed template was pulled up on the computer screen and visible to all. Team members then reviewed the completed assessment and added to the information on-line.

The team leader and the student had developed a figure, mapping out how the different social determinants were linked and impacting each other. Arrows and colour schemes were used to support the graphic image (See Figure 1 below). The figure was presented on the computer screen and discussed with the team.

Figure 1 - Mapping the Social Determinants of Health for the Pregnancy Circle Group

(Figure developed by B. Crawford)

 

PregnancyCircleDiagramjpg


 

One team member addressed the importance of assessing strength of a community rather than focusing primarily on the deficits, in light of the OPHS which were, in her interpretation, moving away from assessing needs. One team member suggested incorporating an appreciative inquiry framework to highlight strength. The discussion resulted in highlighting strength of the program priority population.

Team members wanted more information to complete questions related to identifying the theories linked to each intervention. One team member suggested to consult "Theories at a Glance" from the US National Cancer Institute as an easily accessible resource.

Last Updated on Wednesday, 16 September 2009 17:05