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BackgroundTypically, web-based consumer health information is considered more beneficial for people with high levels of education and income. No evidence shows that equity-oriented information offers equal benefits to all. This is important for parents of low socioeconomic status (SES; low levels of education and income and usually a low level of literacy). ObjectiveThis study is based on a conceptual framework of information outcomes. In light of this, it aims to compare the perception of the outcomes of web-based parenting information in low-SES mothers with that of other mothers and explore the perspective of low-SES mothers on contextual factors and information needs and behavior associated with these outcomes. MethodsA participatory mixed methods research was conducted in partnership with academic researchers and Naître et grandir (N&G) editors. N&G is a magazine, website, and newsletter that offers trustworthy parenting information on child development, education, health, and well-being in a format that is easy to read, listen, or watch. Quantitative component (QUAN) included a 3-year longitudinal observational web survey; participants were mothers of 0- to 8-year-old children. For each N&G newsletter, the participants’ perception regarding the outcomes of specific N&G webpages was gathered using a content-validated Information Assessment Method (IAM) questionnaire. Differences between participants of low SES versus others were estimated. Qualitative component (QUAL) was interpretive; participants were low-SES mothers. The thematic analysis of interview transcripts identified participants’ characteristics and different sources of information depending on information needs. Findings from the two components were integrated (QUAN+QUAL integration) through the conceptual framework and assimilated into the description of an ideal-typical mother of low SES (Kate). A narrative describes Kate’s perception of the outcomes of web-based parenting information and her perspective on contextual factors, information needs, and behavior associated with these outcomes. ResultsQUAN—a total of 1889 participants completed 2447 IAM responses (50 from mothers of low SES and 2397 from other mothers). N&G information was more likely to help low-SES participants to better understand something, decrease worries, and increase self-confidence in decision making. QUAL—the 40 participants (21 N&G users and 19 nonusers) used 4 information sources in an iterative manner: websites, forums, relatives, and professionals. The integration of QUAN and QUAL findings provides a short narrative, Kate, which summarizes the main findings. ConclusionsThis is the first study comparing perceptions of information outcomes in low-SES mothers with those of other mothers. Findings suggest that equity-oriented, web-based parenting information can offer equal benefits to all, including low-SES mothers. The short narrative, Kate, can be quickly read by decision policy makers, for example, web editors, and might encourage them to reach the underserved and provide and assess trustworthy web-based consumer health information in a format that is easy to read, listen, or watch.

Context: Implementing interprofessional advanced access (AA) requires reorganizing the practices of all team members to improve the timeliness of primary care. Often, team members do not know how to engage in a meaningful change process journey. Evidence-based change strategies that address fundamental care delivery processes could help improve timely access to the appropriate professionals while improving satisfaction of both staff and patients. Objective: To describe foundational evidence-based change strategies used by external facilitators to improve interprofessional AA in primary healthcare (PHC) clinics. Study design and analysis: Participatory action research was used to analyze change strategies and steps required for their implementation. AA indicators (3rd next available appointment, continuity of care, and availability for urgent care) were followed longitudinally to adapt the change strategies and assess their progressive impacts. This process led to the development of change packages. Setting: 8 interprofessional PHC clinics in Quebec, Canada. Population studied: Physicians, nurse practitioners, nurses, social workers and pharmacists. Intervention: External facilitators supported PHC clinics while relying on quality improvement techniques according to the Model for Improvement. Outcomes: Change packages: standardized tools to inform the planning, implementation, and monitoring of change strategies. These include: 1) Steps required to implement the strategy; 2) Key indicators to monitor change and evaluate the strategy's success; 3) Lessons learned from the process. Results: 4 different change packages were developed. 3 change packages support transformation of appointment systems, including a prioritization algorithm for appointment scheduling, integration of time slots for urgent care, and integration of an online appointment scheduler. One change package aims to improve patient flow and professional autonomy using collective orders. The contents of these change packages, including lessons learnt and impacts on key indicators of AA across participating clinics, will be presented. Conclusions: Improving AA in PHC is complex, but essential change strategies appeared to be common first steps among clinics undertaking this journey. Resulting change packages provide road maps to successfully guide the improvement of AA, lay a strong foundation for further improvement steps, and build a culture of improvement within and among PHC clinics., Presenters Isabelle Gaboury, PhD, Mylaine Breton, PhD, Francois Bordeleau, MSc, Kathy Perreault, PsyD, MPsy, Elisabeth Martin, MSc, Marie-Eve Poitras, PhD, MSc, RN, Sabina Malham, PhD, MSc, RM, Lara Maillet, PhD, [...]

Context: Almost all parents search web-based information for their children. This study focuses on parents with low socioeconomic status (SES), a correlate of health literacy (determinants of child education/health); specifically, their experience of seeking information on the Naitre et Grandir (N&G) website (trustworthy information on child development, education and health in clear language). Objectives: To measure the influence of a health literacy intervention on (a) the frequency of the utilization of a questionnaire to understand the perceived outcomes of N&G information, and (b) parents' expected benefits of this information. Study Design and Analysis: A 4-year prospective time series. Statistical analyses were descriptive and inferential. Setting: For each N&G webpage, parents are invited to complete a questionnaire (Information Assessment Method, IAM) to report their intention to use and expected benefits of the webpage information. Population studied: Quebec parents of 0-8-year-old children who completed at least one IAM questionnaire. Intervention: An improved version of the IAM, the IAM+ was developed with low SES parents and implemented in January 2019. Main outcome measures: IAM data were collected in the pre-intervention (2017-2018) and the post-intervention (2019-2020) periods. Results: Participants completed 10,362 IAM questionnaires. The proportion of responses and reported benefits from low SES participants increased post-intervention. Low SES participants and particularly low SES fathers expected greater benefits from the accessed web information compared to other participants and mothers. Conclusions: Results suggest (a) family physicians recommend trustworthy easy-to-read information resources to all patients when needed, including patients with a low literacy level; (b) web content that incorporates international health literacy standards is associated with greater expected benefits among low SES parents; (c) increasing father awareness and father-inclusive content can lead to greater expected benefits; and (d) the IAM questionnaire that is accessible on all devices, including smartphones, can help low SES parents provide feedback to web editors regarding the outcomes of their content., Presenters Pierre Pluye, MD, PhD, Albina Tskhay, Roland Grad, MD, MSc, FCFP, Melanie Barwick, PhD, CPsych, Genevieve Doray, Gillian Bartlett-Esquilant, PhD, Christine Loignon, PhD, Araceli Gonzalez Reyes, MSc, Reem El [...]

PURPOSE To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices. METHODS A pragmatic randomized controlled trial with a mixed-methods design in patients aged 18 to 80 years with 3 or more chronic conditions from 7 family medicine groups (FMGs) in Quebec, Canada. Health care professionals (nurses, nutritionists, kinesiologists) from the FMGs were trained to deliver the patient-centered intervention based on a motivational approach and self-management support. Primary outcomes: self-management (Health Education Impact Questionnaire); and self-efficacy. Secondary outcomes: health status, quality of life, and health behaviors. Quantitative analyses used multi-level mixed effects and generalized linear mixed models controlling for clustering within FMGs. We also conducted in-depth interviews with patients, family members, and health care professionals. RESULTS The trial randomized 284 patients (144 in intervention group, 140 in control group). The groups were comparable. After 4 months, the intervention showed a neutral effect for the primary outcomes. There was significant improvement in 2 health behaviors (healthy eating with odds ratios [OR] 4.36; P = .006, and physical activity with OR 3.43; P = .023). The descriptive qualitative evaluation revealed that the patients reinforced their self-efficacy and improved their self-management which was divergent from the quantitative results. CONCLUSIONS Quantitatively, this intervention showed a neutral effect on the primary outcomes and substantial improvement in 2 health behaviors as secondary outcomes. Qualitatively, the intervention was evaluated as positive. The combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention. Key words: interdisciplinary research; multimorbidity; patient care team; pragmatic clinical trial, INTRODUCTION Much effort has been deployed internationally to improve care and outcomes for persons with multimorbidity in primary care. The Patient-Centered Innovations for Persons with Multimorbidity research program, funded by [...]

The advanced access (AA) model is among the most recommended innovations for improving timely access in primary health care (PHC). Originally developed for physicians, it is now relevant to evaluate the model's implementation in more interprofessional practices. We compared AA implementation among family physicians, nurse practitioners, and nurses. A cross-sectional online open survey was completed by 514 PHC providers working in 35 university-affiliated clinics. Family physicians delegated tasks to other professionals in the team more often than nurse practitioners (p =.001) and nurses (p <.001). They also left a smaller proportion of their schedules open for urgent patient needs than did nurse practitioners (p =.015) and nurses (p <.001). Nurses created more alternatives to in-person visits than family physicians (p <.001) and coordinated health and social services more than family physicians (p =.003). During periods of absence, physicians referred patients to walk-in services for urgent needs significantly more often than nurses (p =.003), whereas nurses planned replacements between colleagues more often than physicians (p <.001). The variations among provider categories indicate that a one-size-fits-all implementation of AA principles is not recommended. [ABSTRACT FROM AUTHOR]

The knowledge translation movement in health has led to the production of vast amounts of knowledge tools aimed at broadening clinicians' evidence base and improving the quality and efficacy of their practices. However important, these tools, largely oriented towards biomedical and technological aspects of care, are of limited potential for addressing the complex interactions between patients' socio-economic contexts and their health. Yet health professionals frequently lack the sensitivity, knowledge and ability to incorporate approaches to poverty within their practices; this is partly due to their limited understanding of the lived experience of poverty and of the complexity of barriers underprivileged people face to achieve and maintain health. In a context of persisting social inequalities in oral health, the Montreal-based Listening to Others multi-stakeholder partnership has been engaged in developing health professional education on poverty since 2006. In this article, we describe and reflect on how service users representing the Québec antipoverty coalition, academics from University of Montreal and McGill University, representatives of Québec dental regulatory bodies and artists collaborated to produce an educational film on poverty. Project partners' specific contributions to the film script are highlighted, emphasizing their potential to enrich the health professional educator's practice knowledge base. In doing so, this article provides an explicit and concrete example of how participatory processes can support co-learning and knowledge co-production through engagement with the arts. The overall aim is to demonstrate how participatory research can enhance knowledge translation by producing educational tools that promote critical reflection and address complexity.