The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #70532

Sara La Tour, MSc, Viviane Leaune, MSc, Lise Renaud, PhD, Sylvie Chevalier, MSc, and Gilles Paradis, MD, MSc, FRCPC. Institut national de santé publique, Direction de santé publique de Montréal-centre, 1301, Sherbrooke est, Montréal, QC H2L 1M3, Canada, (514) 528-2400 #3358, slatour@santepub-mtl.qc.ca

Although health professionals (HP: physicians, nurses, nutritionists, social workers) have a key role to play in reducing cardiovascular risk factors at the individual and community levels, little is known about the factors associated with implementation of best practice guidelines by HP. As part of a community-based trial which evaluates a public health department program to disseminate best practice guidelines in heart health in 20 local community clinics (LCC) in Quebec, we conducted 154 semi-structured telephone interviews with HP, LCC middle-managers and administrators at baseline. In addition, we conducted 60 telephone interviews with LCC project leaders and 15 in-depth interviews with public health intervention agents over the first year of intervention. Meeting minutes and planning documents were also reviewed. Cross-sectional comparisons between LCCs and between types of respondents and longitudinal comparison of the stages of implementation of the program during the first year of intervention in the LCCs were conducted using NUD*IST 4 software. Results suggest a complex system of factors influencing implementation including financial support, characteristics of services and organizational culture, perceptions of preventive practices and of HP roles, managers and staff leadership, mutual perceptions of the LCCs and public health departments. Particularly, the role of public health departments appears central as it determines the characteristics of implementation including the objectives and structure of interventions and the number of HP targeted by the program. In conclusion, the information provided by this process evaluation is a helpful tool for program planning and for understanding the mechanisms by which successful dissemination occurs.

Learning Objectives:

• 3. Recognise the most important obstacles and facilitators to program implementation concerned with the dissemination of best practices.
  7. Apply those information to the knowledge and understanding of other programs and identify best strategies to maximise new program implementation.
  11. Assess public health department role on new programs’ implementation.

Keywords: Evaluation, Practice Guidelines

Related Web page: www.inspq.qc.ca/aucoeurdelavie

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.