Improving Breastfeeding Education of Health Professionals in Québec

Improving Breastfeeding Education of Health Professionals in Québec Isabelle Michaud-Létourneau, PhD, MPH, RD Chantal Doucet, DC, DICCP 2017 Baby-Friendly Initiaitive National Symposium Moncton, Canada September 22 nd, 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 1

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

Context 4

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 improved infant and young child feeding everywhere, 2016, p.25

Rate of total BF & exclusive BF in Quebec by infant s age % 90 80 70 60 50 40 Whereas 85 % of mothers breastfeed at discharge (infant is 2 days old) Only 50 % exclusively breastfeed!!! 30 20 10 0 At discharge 1 week 1 month 2 months 3 months 4 months 5 months 6 months 7 Adapted from Neill et al.: Recueil statistique sur l allaitement maternel au Québec, 2005-2006, Québec, Institut de la statistique du Québec

UNICEF, From the first hour of life Making the case for improved infant and young child feeding everywhere, 2016, p.19 8

Factors associated with breastfeeding Mother s decisions Breastfeeding practices Possibility of turning decisions into actions Individual level factors Group level factors Society level factors Workplaces Childcare settings Mother s attributes Infant s attributes Attributes of the mother-child dyad Characteristics of the environments Health and Health social services professionals Community organizations Education network Virtual spaces Public policies Public transportation Societal, cultural and economic attributes Family, medical and cultural attitudes and norms Demographic and economic conditions Commercial pressures National and international policies and standards Family setting Restaurants Municipal settings Commercial settings 9 (Lauzière, 2015; adapted from Hector et al., 2005, Lutter, 2000, & Lauzière, 2010)

Working Upstream Cégeps (Colleges), universities Health professionals 10

Who we are? 11

Quebec Breastfeeding Movement Founded in April 2009 Mission Promote enabling environments for breastfeeding Optimal development of young children and wellbeing 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

What has been achieved? so far - Initiative of 4 stages - 16

RESULTS Stage 1 Stage 1: Assessing BF training 2010-11 2013-15 2015-16 2017 2020 PROCESSES

Survey Urgent need to address the gaps in training of health Dentists, nurses, medical doctors, registered dietitians, professionals on breastfeeding pharmacists, midwives because it may take 5-10 years before changes are in place! 18

RESULTS Stage 2 Stage 2: Agenda setting and engaging key actors Stage 1: Assessing BF training 2010-11 2013-15 2015-16 2017 2020 PROCESSES

Newsletters 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: As of today, the MAQ has gathered more than 180 professors and program administrators across Québec who showed interest or Work of the CoT (presentations, funding search, etc) Information on breastfeeding and breastfeeding training (public statements, recommendations, engagement publications, future conferences, etc.) High opening rate = The topic resonates with subscribers 20

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

P Strategic Workshop STRATEGIC PLANNING WORKSHOP FOR HEALTH PROFESSIONALS INITIAL TRAINING ON BF AVRIL 2016 COLLOQUE DE PLANIFICATION STRATÉGIQUE POUR LA FORMATION DES PROFESSIONNELS DE LA SANTÉ EN MATIÈRE D ALLAITEMENT AU QUÉBEC 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. Objectives {Source: Mouvement allaitement du 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). 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 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 22

Participants (48) Regions Capitale-Nationale Estrie Laval Mauricie Montérégie Montréal Outaouais + Ottawa (Ontario) + Moncton (NB) Functions Professions Chiropractors Lactation Consultants Dentists Nurses Medical doctors Nutritionists Pharmacists Midwives Organizations Assistant deans, program directors Colleges (Cégeps) Universities (Québec and 2 other provinces) Professional Orders Others: Ministry of Health and Social Services, Health services network and clinical settings MAQ Professors, teachers, lecturers, practicum coordinators Students Delegates of Regulatory bodies and other establishments Practicing professionals others Volunteers 23

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 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) 25

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 Champion Funding BARRIERS Maintaining participants interest Engaging decisionmakers 26

RESULTS Stage 3 Stage 3: Reaching consensus on a common agenda, transversal BF objectives, and shared indicators and measurements Stage 2: Agenda setting and engaging key actors Stage 1: Assessing BF training 2010-11 2013-15 2015-16 2017 2020 PROCESSES

Common Agenda - Priority Actions 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 28

Going Forward 29

RESULTS Stage 4 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 3: Reaching consensus on a common agenda, transversal BF objectives, and shared indicators and measurements Stage 2: Agenda setting and engaging key actors Stage 1: Assessing BF training 2010-11 2013-15 2015-16 2017 2020 PROCESSES

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 Condition Common agenda Shared measurement Mutually reinforcing activities Continuous communication Backbone support Definition 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. All participating organizations agree on the ways success will be measured and reported, with a short list of common indicators identified. A diverse set of stakeholders, typically across sectors, coordinate a set of differentiated activities through a mutually reinforcing plan of action. All players engage in frequent and structured open communication to build trust, assure mutual objectives, and create common motivation. 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. 32 Source: Kania, J. and M. Kramer, Embracing emergence: How collective impact addresses complexity., January, 2013. 21.

Legend Academic institutions Practitioners-clinicians Other key partners Collective Impact initiative Quebec Setting the Initiative - QC

Legend Academic institutions Practitioners-clinicians Other key partners Collective Impact initiative Quebec Setting the Initiative - QC Ontario N-B Setting the initiative with other provinces Others interested in joining the initiative?

Legend Academic institutions Practitioners-clinicians Other key partners Collective Impact initiative Quebec Setting the Initiative - QC Ontario N-B Setting the initiative with other provinces Others interested in joining the initiative? Isabelle Michaud-Létourneau: im225@cornell.edu

Enhanced BF competencies in health centers and hospitals Enhanced BF knowledge, attitudes and practices in initial training Curricula changes in 3 provinces Strategic planning workshop (Qc) Identify barriers and enablers to curricula changes Agree on minimal BF objectives Develop a targeted BF curriculum for pediatric residents Planning a national BF educational intervention for medical residents Get funding for a strategic workshop in Québec Identification of: BF trainings gaps in 6 health professions in Qc Potential deficits in BF knowledge & attitudes of Canadian physicians Stages and actions leading to a Collective Impact Initiative RESULTS 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 Stage 3: Reaching consensus on a common agenda, transversal BF objectives, and shared indicators and measurements Stage 2: Agenda setting and engaging key actors in universities, colleges and professional associations Stage 1: Assessing BF training and consulting stakeholders 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) 2013-15 2015-16 Newsletters (6) to engage with key actors (professors) Proposal writing to get funding for workshop Increased communication between MAQ and researchers 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 PROCESSES 2017 2020 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

Acknowledgments 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 Several anonymous donors have also contributed to this event through a crowdfunding campaign and we thank them warmly. 37

THANK YOU 38

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