Interactive Domain Model (IDM) /Interactive Domain Model (IDM) /Modèle des domaines interactifs (MDI)Modèle des domaines interactifs (MDI)DevelopingDeveloping a user-friendly context-sensitive best a user-friendly context-sensitive best

practices approach to achieve health promotion & practices approach to achieve health promotion & public health goalspublic health goals

Barbara Kahan (Member, Centre for Health Promotion, University of Toronto)Barbara Kahan (Member, Centre for Health Promotion, University of Toronto)Christiane Fontaine (Consultant, Ontario Prevention Clearinghouse)Christiane Fontaine (Consultant, Ontario Prevention Clearinghouse)

Peggy Schultz (Consultant, Ontario Prevention Clearinghouse)Peggy Schultz (Consultant, Ontario Prevention Clearinghouse)Michael Goodstadt (Member, Centre for Health Promotion, University of Toronto)Michael Goodstadt (Member, Centre for Health Promotion, University of Toronto)

poster display for

A Workshop on the Canadian Best Practices System for Chronic Disease

Prevention

Toronto (Canada), March 10-11, 2005

IDM/MDI information & resources are IDM/MDI information & resources are available from:available from:

www.idmbestpractices.ca

www.opc.on.ca/francais/nosprogrammes/centre/projets/meilleurespratiques.htm

www.bestpractices-healthpromotion.com

www.utoronto.ca/chp/bestp.html

IDM/MDI definition of best practicesIDM/MDI definition of best practices Best practices are those sets of processes and activities Best practices are those sets of processes and activities

which are consistent with health promotion/public health which are consistent with health promotion/public health values, goals and ethics, theories and beliefs, evidence, values, goals and ethics, theories and beliefs, evidence, and understanding of the environment, and that are most and understanding of the environment, and that are most likely to achieve health promotion/public health goals in likely to achieve health promotion/public health goals in any given situation.any given situation.

In brief, the IDM approach is about increasing consistency In brief, the IDM approach is about increasing consistency between practice and a range of decision making factors between practice and a range of decision making factors such as values, theories, beliefs, evidence, and such as values, theories, beliefs, evidence, and understanding of the environment.understanding of the environment.

Définition des meilleures pratiquesDéfinition des meilleures pratiques

Ensemble des processus et activités les plus susceptibles d’atteindre les objectifs de promotion de la santé dans une situation donnée tout en respectant les valeurs, buts, principes éthiques, théories, croyances, constatations et contextes environnementaux de la promotion de la santé.

En résumé, l’approche du modèle des Domaines interactifs permet d’être consistent entre la pratique et les facteurs qui peuvent influencer la prise de décision (valeurs, théories, croyances et l’environnement) l’environnement)

Les meilleures pratiques Les meilleures pratiques en promotion de la santéen promotion de la santé

••Permet de maximiser les avantages associés à des meilleures Permet de maximiser les avantages associés à des meilleures pratiques et d’en minimiser les risques potentiels en promotion pratiques et d’en minimiser les risques potentiels en promotion de la santéde la santé

etet

••Prend en considération :Prend en considération :• • tous les facteurs importants qui influencent la pratique;tous les facteurs importants qui influencent la pratique;

• • les circonstances uniques de chaque situation;les circonstances uniques de chaque situation;

• • la relation entre les procédés (processus) et résultats.la relation entre les procédés (processus) et résultats.

Le Modèle des domaines interactifs Le Modèle des domaines interactifs (MDI) …(MDI) …

••Peut servir d’outil de planification, d’implantation et d’évaluation que ce soit Peut servir d’outil de planification, d’implantation et d’évaluation que ce soit pour un projet, un programme ou un exercice de planification stratégique; pour un projet, un programme ou un exercice de planification stratégique;

••Permet une cohérence entre les valeurs et les activités qui découlent de la Permet une cohérence entre les valeurs et les activités qui découlent de la planification;planification;

••C’est un outil qui encourage la discussion portant sur le développement d’une C’est un outil qui encourage la discussion portant sur le développement d’une vision commune et des valeurs partagées au sein du groupe qui l’utilise;vision commune et des valeurs partagées au sein du groupe qui l’utilise;

••Met en évidence une approche basée sur la promotion de la santé;Met en évidence une approche basée sur la promotion de la santé;

••Son application qui ne se limite pas au domaine de la promotion de la santé Son application qui ne se limite pas au domaine de la promotion de la santé mais il est aussi adaptable culturellement et linguistiquement et ce, dans mais il est aussi adaptable culturellement et linguistiquement et ce, dans différents milieux de travail.différents milieux de travail.

  

Le MDI permet…Le MDI permet…

de jeter un regard critique qui nous permet de faire des de jeter un regard critique qui nous permet de faire des choix et prendre des décisions (p.ex. pratique actuelle ou choix et prendre des décisions (p.ex. pratique actuelle ou proposée) basés sur des données probantes;proposée) basés sur des données probantes;

d’analyser plus profondément les lacunes et les besoins: ce d’analyser plus profondément les lacunes et les besoins: ce que l’on doit changer, arrêter, commencer ou continuer;que l’on doit changer, arrêter, commencer ou continuer;

  de développer un plan d’action qui assure une cohérence de développer un plan d’action qui assure une cohérence entre les objectifs, activités et évaluation sont cohérentes entre les objectifs, activités et évaluation sont cohérentes entre eux;entre eux;

  et d’avoir un regard critique sur ce qui a été fait et d’avoir un regard critique sur ce qui a été fait (évaluation).(évaluation).

Timeline: 1996-1997Timeline: 1996-1997 Practitioners at the International Symposium on the Practitioners at the International Symposium on the

Effectiveness of Health Promotion express a desire to actively Effectiveness of Health Promotion express a desire to actively participate in resolving issues related to evaluation and participate in resolving issues related to evaluation and effectiveness of health promotion. effectiveness of health promotion.

The Centre for Health Promotion, University of Toronto, creates The Centre for Health Promotion, University of Toronto, creates the Continuous Quality Improvement (CQI) Work Group; the Continuous Quality Improvement (CQI) Work Group; members represent a variety of sectors: members represent a variety of sectors: public health units public health units community health centres community health centres hospitals hospitals community groups community groups provincial government provincial government federal government federal government academic institutions academic institutions private sector private sector

Health Canada, Population and Public Health Branch (currently Health Canada, Population and Public Health Branch (currently Public Health Agency of Canada, Ontario and Nunavut Region), Public Health Agency of Canada, Ontario and Nunavut Region), funder of the Symposium, also funds the next five years of what funder of the Symposium, also funds the next five years of what becomes the Best Practices Project.becomes the Best Practices Project.

CQI Work Group Members clarify their understanding of CQI Work Group Members clarify their understanding of concepts and practices related to CQI and how CQI might concepts and practices related to CQI and how CQI might contribute to health promotion practice.contribute to health promotion practice.

Timeline: 1997-1998Timeline: 1997-1998 A literature review and synthesis by one of the members results A literature review and synthesis by one of the members results

in two background papers (on CQI and best practices) for in two background papers (on CQI and best practices) for reference use by the CQI Work Group. reference use by the CQI Work Group.

Members decide to become the Best Practices Work Group.Members decide to become the Best Practices Work Group. Members participate in a series of hands-on workshops. Members participate in a series of hands-on workshops.

Through these workshops they explore best practices, in the Through these workshops they explore best practices, in the process identifying potential benefits and risks and developing process identifying potential benefits and risks and developing their own set of best practices principlestheir own set of best practices principles ..

Timeline: 1998-1999Timeline: 1998-1999 The original best practices Model evolves. It is now based on The original best practices Model evolves. It is now based on

three interactive components or “domains” which exist in the three interactive components or “domains” which exist in the context of social, political, psychological, and physical context of social, political, psychological, and physical environments: underpinnings, understanding of the environment, environments: underpinnings, understanding of the environment, and practice.and practice.

A Framework, designed to implement the Model in practice, is A Framework, designed to implement the Model in practice, is developed. It contains a cycle of steps which are applied to the developed. It contains a cycle of steps which are applied to the Model’s domains. The Framework’s questions are:Model’s domains. The Framework’s questions are: Where are we now? Where are we now? Where do we want to go? Where do we want to go? How do we get there? How do we get there? What principles guide us? What principles guide us? What did we do? What did we do? How did we do it? How did we do it? What were the results? What were the results? What do we need to change? What do we need to change?

A set of suggested guiding principles and criteria is drafted. A set of suggested guiding principles and criteria is drafted.

Timeline: 1998-1999Timeline: 1998-1999 continued continued The Work Group conducts an Ontario scan of practitioners’ needs and The Work Group conducts an Ontario scan of practitioners’ needs and

capacities regarding best practices, using interviews and a survey. capacities regarding best practices, using interviews and a survey. A years-long series of national and international workshops, A years-long series of national and international workshops,

presentations and consultations begins with groups ranging from the presentations and consultations begins with groups ranging from the Ontario Public Health Association to the International Union of Ontario Public Health Association to the International Union of Health Promotion and Education.Health Promotion and Education.

The Centre for Health Promotion’s Best Practices Work Group joins The Centre for Health Promotion’s Best Practices Work Group joins with the Association of Ontario Health Centres and the Ontario Public with the Association of Ontario Health Centres and the Ontario Public Health Benchmarking Partnership to form the Best Practices Health Benchmarking Partnership to form the Best Practices Partnership.Partnership.

Timeline: Timeline: 1999-20001999-2000

The Best Practices Partnership pilots the draft IDM approach (based on the Model and its operational Framework) with three Ontario sites:- Durham Region Health Department - East End Community Health Centre (TO) - The Willett Hospital (Paris)

Facilitators consult extensively with each site to take into account local internal and external conditions. As a result, focus issues and processes for working through the Framework vary from site to site.

Facilitators conduct workshops and provide supporting materials to introduce basic concepts. In between workshops site participants work to develop their own frameworks, contacting the facilitators as required when questions arise.

Timeline: Timeline: 1999-20001999-2000 continued continued

Positive pilot test results include: for the approach: confirmation that the Model and Framework are flexible enough to be used in different situations, in different ways, and for different purposes; and, identification of ways to improve IDM processes and materials (e.g. gaps to fill, concepts to clarify, explanations to reword, exercises to reorganize, essential supports to put in place) for one or more sites: increases in knowledge, skills, understanding, group cohesion, consensus, enthusiasm, systematic planning, credibility, and ability to identify and address work-related issues (e.g. clinical vs. non-clinical perspectives, restructuring, funding)

Possible negative/lack of impact on individual pilot sites include: volunteer disaffection, resistance, no change in planning process.

Based on facilitator and participant observations and evaluation results (group discussions and written feedback) the Framework and materials are modified.

Timeline: Timeline: 1999-20001999-2000 continued continued

The Francophone sub-committee is formed, with a mandate to adapt the Interactive Domain Model (IDM) to the Franco-Ontarian context. Members include representatives from academic, government and community sectors. What is currently the Public Health Agency of Canada, Ontario and Nunavut Region, provides funding.

Timeline: 2000-2001Timeline: 2000-2001 The Francophone sub-committee conducts a needs assessment The Francophone sub-committee conducts a needs assessment

to document the needs of Francophone practitioners and their to document the needs of Francophone practitioners and their capacities and interest regarding best practices in health capacities and interest regarding best practices in health promotion.promotion.

The Ontario Hospital Health Promotion Network joins the The Ontario Hospital Health Promotion Network joins the Best Practices Partnership.Best Practices Partnership.

The first version of the The first version of the IDM Manual for Best Practices in IDM Manual for Best Practices in Health PromotionHealth Promotion is produced. is produced.

The peer-reviewed journal The peer-reviewed journal Health Promotion PracticeHealth Promotion Practice publishes an article explaining IDM Best Practices key publishes an article explaining IDM Best Practices key concepts.concepts.

Following a suggestion from one of the original pilot sites, the Following a suggestion from one of the original pilot sites, the IDM Computer Program is developed.IDM Computer Program is developed.

Timeline: 2000-2001Timeline: 2000-2001 continued continued The Ontario Ministry of Health and Long Term Care funds the The Ontario Ministry of Health and Long Term Care funds the

development of an IDM “bridging the gap between research development of an IDM “bridging the gap between research and practice” learning module. Six sites participate:and practice” learning module. Six sites participate: Access Alliance Multicultural CHC (Toronto) Access Alliance Multicultural CHC (Toronto) Brant Community HealthCare System (Paris and Brantford) Brant Community HealthCare System (Paris and Brantford)

Peterborough County-City Health Unit Peterborough County-City Health Unit Sudbury and District Health Unit Sudbury and District Health Unit St. Joseph's Healthcare, Women's Detox and Mary Ellis St. Joseph's Healthcare, Women's Detox and Mary Ellis House Treatment Program (Hamilton) House Treatment Program (Hamilton) West Hill Community Health Centre (Toronto) West Hill Community Health Centre (Toronto)Results are positive.Results are positive.

Timeline: 2002-presentTimeline: 2002-present

The Francophone sub-committee:The Francophone sub-committee: adapts and translates into French the IDM Manual and adapts and translates into French the IDM Manual and article article develops French-language IDM training modules develops French-language IDM training modules conducts three workshops with 30 participants from conducts three workshops with 30 participants from health and education sectors and community-based groups health and education sectors and community-based groups in Sudbury, Ottawa and Torontoin Sudbury, Ottawa and Toronto develops a website develops a website

An IDM Best Practices Road Map for Coaches and Best An IDM Best Practices Road Map for Coaches and Best Practices Check-In Forms are produced.Practices Check-In Forms are produced.

Groups continue to use the IDM, for example:Groups continue to use the IDM, for example: The Association des communautés francophone de The Association des communautés francophone de l'Ontario – Toronto, which has a multi-cultural membership l'Ontario – Toronto, which has a multi-cultural membership and is volunteer basedand is volunteer based Womankind Addiction Service, a new approach to Womankind Addiction Service, a new approach to women’s addictions which provides a complete range of women’s addictions which provides a complete range of services in one placeservices in one place

Timeline: 2002-presentTimeline: 2002-present continued continued

The IDM continues to influence models and frameworks The IDM continues to influence models and frameworks being developed by other groups, for example:being developed by other groups, for example: The IDM was “an insightful resource in developing this The IDM was “an insightful resource in developing this Nova Scotia Best Practices Framework.”Nova Scotia Best Practices Framework.” “The IDM informed the best practices work we did at the “The IDM informed the best practices work we did at the AOHC [Association of Ontario Health Centres], AOHC [Association of Ontario Health Centres], particularly the principles piece.”particularly the principles piece.” “ “The development of The development of ‘Core Domain #2 - The ‘Core Domain #2 - The Underpinnings of Best Practices’Underpinnings of Best Practices’ [in a not yet released [in a not yet released practice framework] was inspired and influenced practice framework] was inspired and influenced significantly by the [IDM].”significantly by the [IDM].”

Moving into the FutureMoving into the FutureThe holistic IDM/MDI, which considers a wide range of decision-The holistic IDM/MDI, which considers a wide range of decision-

making factors making factors from values and theories to evidence and context from values and theories to evidence and context is a usable and effective approach for achieving best practices. is a usable and effective approach for achieving best practices.

The approach is constantly evolving, to reflect users’ needs. IDM tools The approach is constantly evolving, to reflect users’ needs. IDM tools are helpful at different levels of work, e.g. to ensure that the key are helpful at different levels of work, e.g. to ensure that the key elements of health promotion and/or public health are included in a elements of health promotion and/or public health are included in a program, to assist in reflection on processes, activities and program, to assist in reflection on processes, activities and outcomes, to encourage inclusivity. outcomes, to encourage inclusivity.

Providing support Providing support to further develop, improve to further develop, improve and disseminate IDM/MDI processes and and disseminate IDM/MDI processes and

resources will contribute significantly to the resources will contribute significantly to the achievement of best practices and health achievement of best practices and health

promotion/public health goals.promotion/public health goals.

MDIMDIMots-clésMots-clés

Vision communeVision communeEngagement Engagement CollaborationCollaboration

FlexibilitéFlexibilitéPerseverancePerseverance

ComplémentaritéComplémentarité

IDMIDMKey conceptsKey concepts

Engagement of all Engagement of all key stakeholders key stakeholders

Ongoing reflectionOngoing reflection& improvement& improvement

Practice based on Practice based on values, theories, values, theories, evidence, contextevidence, context

A few Best Practices Work Group members A few Best Practices Work Group members in front of the Centre for Health Promotion, in front of the Centre for Health Promotion,

University of TorontoUniversity of Toronto

Internal & external environments(social, political & economic structures &systems; psychological and physical conditions)

HP Practiceprocesses & activities directed to:

health-relatedissues

research &evaluation

org./work-related issues

Underpinnings of BP in HP Understanding of the Environment

HP analysis:org./work-

related issues

HP analysis:health-related

issues

HP visionHP values /

goals / ethics

HP theories /beliefs

HP evidence

The Interactive Domain Model of Best Practices in Health PromotionKahan & Goodstadt 2001

Step 1: Prepare Foundation for Action re. selectedissue

Step 2: Make Action & Evaluation Plan How do we get to where we want to go: who does what, when &

how?

Step 3: DocumentImplementation of Plan

Step 4: Revise

1a. criteria &guiding principles What will

guide us?

1b. currentsituation Where are

we now?

1c. picture ofideal situation Where do

we want togo?

2a. specificobjectives toachieve ideal

2b. resources 2c. challenges 2d. evaluationplan

3a. activities &processes What did we

do? How didwe do it?

3b. outcomes ofactivities &processes what were the

results?

4a. revisions what do we

need tochange?

UNDERPINNINGS

values/goals/ethics

theories/beliefs

evidence

UNDERSTANDINGOF ENVIRONMENT

vision ofenvironments

analysis of org/workissues

analysis of healthissues

PRACTICEprocesses/activities

response toorg/work issue

response to healthissues

research/evaluation

IDM Framework (Kahan & Goodstadt, 2001)

Internal & external environments(social, political & economic structures & systems;

psychological and physical conditions)

The use of research & evidence in promoting the effectiveness of health promotion practice(Using the Interactive Domain Model of Best Practices in Health Promotion)

(Barbara Kahan & Michael Goodstadt, 2001)

CriteriaRelevant to HP questions

Reflect HP underpinnings &understanding of environment

High QualityApplicable to specific situation

HP GOALS

3. Make HP BestPractices Decisions

4. Implement HP Best Practice decisions(processes & activities)

implement decisions re. org/work- & health-related issues

5. Evaluate practice

6. Revise decisions/practice

(Other) underpinnings of BP in HPvalues/goals/ethics

theories/beliefsevidence

HP Understanding of environmentvision

analysis

1. Ask HP Question(s)based on HP underpinnings,

understanding of the environment, practice

HP Evidencerelated to external situations

HP Evidencerelated to specific situation

2. HP research/evidenceidentification, selection, analysis, synthesis, reporting

Internal & external environments(social, political & economic structures & systems;

psychological and physical conditions)

Taking a Best Practices Approach in Developing Health Promoting Public Policy(Barbara Kahan & Michael Goodstadt, 2001)

Implementation

Research &evaluation

HP GOALS

Make Health Promotion Best Practices Decisions

Supportingactivities &strategies

Health PromotingPublic Policies

Underpinnings ofBest Practices in HP

HP values, goals & ethicsHP theories/beliefs

HP relevant evidence

HP understandingof environments

HP visionHP analysis of health-related issueHP analysis of organization/work-

related issues