Intersectoral Collaboration Research Articles

Gastrointestinal helminths infection of free-roaming cats (Felis catus) in Southeast Iran.

Cats in Iran are definitive hosts for several zoonotic intestinal helminths, such as Toxocara cati, Dipylidium caninum, Toxascaris leonina, Physaloptera praeputialis and Diplopylidium nolleri. This study aimed to determine the prevalence of intestinal helminth infection in free-roaming cats in southeast Iran, a region with a high free-roaming cat population. From January 2018 to December 2021, 153 cadavers of free-roaming cats from Southeast Iran were necropsied for intestinal helminth infections. The carcasses were dissected, and the digestive systems were removed. The esophagus, stomach, small intestine, caecum and colon were tightly ligated. All adult helminths were collected, preserved and identified. The prevalence of gastrointestinal helminth infections was 80.39% (123/153). Of the cats from Kerman, 73% (73/100) were infected with at least one helminth, including D. caninum 70% (70/100), T. leonina 8% (8/100) and P. praeputialis 17% (17/100). Concurrent infection with two helminth species was found in 16% (16/100) and of three species infections was found in 3% (3/100) of the cats. Of the cats from Zabol, 94.33% (50/53) were infected with at least one of the helminths, including D. caninum 69.81% (37/53), T. leonina 11.32% (6/53), P. praeputialis 37.73% (20/53) and T. cati 5.66% (3/53). Concurrent infection with two helminth species was found in 28.3% (15/53), and three species were found in 1.88% (1/53) of the cats. Helminth infections were more prevalent in older cats. There was no association between sex and infection rate. Based on the very high prevalence of zoonotic intestinal helminth infections in free-roaming cats in southeast Iran, the potential public health risk emphasizes the need for intersectoral collaboration, particularly the provision of health and hygiene education to high-risk populations, such as pre-school and school-age children.

INVOLVEMENT OF DIFFERENT STAKEHOLDER GROUPS IN ENSURING CHILDREN’S DENTAL PUBLIC HEALTH: ANALYSIS AND PERSPECTIVES

Introduction: Strengthening the dental public health (DPH) of the pediatric population requires prioritizing development with the identification of key stakeholders and their leading functions.
 The aim. To analyze the current state and identify prospects for intra-industry and inter-sectoral cooperation in the process of strengthening the dental public health of the child population to justify ways of optimization.
 Materials and methods. A cross-sectional study using expert assessments involving 15 highly competent experts (competence level above 0.85) was conducted through a specially designed program. Bibliosemantic and sociological methods were employed. Expert assessments and stakeholder mapping were performed, visualizing the «authority-interest» relationship of different interested groups on a two-dimensional model. The results were analyzed using standard statistical methods with the application of Jupyter Notebook (https://jupyter.org/install). Intra-class correlation coefficients were used to assess the agreement of expert opinions. A significance level of p<0.05 was considered critical in testing all statistical hypotheses.
 Results. The graphical analysis allowed for the identification of stakeholders and determination of their roles in the DPH system. Groups with high and low levels of power and interest were identified. The agreement among experts regarding the determination of power and interest was respectively ICC=0.76 (95% CI 0.56 – 0.91) and ICC=0.79 (95% CI 0.59 – 0.92). The necessity of targeted efforts with each group, considering their capabilities and limitations, was emphasized. Key stakeholders included families, communities, family physicians, public health institutions, pediatric dentists, and others. Primary functions aimed at strengthening children’s dental health were attributed to influencing determinants of dental health, intersectoral collaboration and support for relevant initiatives at the local level are essential.
 Conclusions. The importance of developing and implementing programs aimed at improving the dental health of the child population has been established. Emphasis is placed on the significance of collaboration among various stakeholders in supporting a strategic approach to managing DPH.

Encouraging Intersectoral Collaboration to Promote Medical Tourism in South Africa

Rebuilding is a prominent theme in a post pandemic era where economies are looking to attract all opportunities to recover. Tourism has always been a key driver to boost economies particularly in countries which are rich in cultural diversity and natural beauty. South Africa, which already has a thriving tourism industry, has seen an increase in medical tourists who are motivated by the desire to avoid high healthcare costs, long wait times for services and specific procedures that are not offered in their own countries. South Africa's private healthcare system is world-class for medical tourism because it is supported by a thriving medical insurance market. The rise of medical tourism in South Africa has stemmed from synergies formed with the private sector healthcare system because of the growth of tourism. Currently, only private sector hospitals are involved in rendering services related to medical tourism. The current rollout of the National Health Insurance (NHI) poses as an opportunity for the public healthcare sector to also benefit from the revenue generated by medical tourism, however there are challenges that exist that must be alleviated. This paper will begin with an overview of the medical tourism and healthcare sectors in South Africa based on secondary research conducted. Thereafter the empirical data highlighting challenges experienced at selected public central hospitals in South Africa will be presented. The paper will then explore the collaboration potential of the tourism and healthcare industries to overcome the challenges presented. Recommendations will be contributory in highlighting the need for revenue to restore trust in the public healthcare sector and boost medical tourism. The empirical study, through adopting a descriptive exploratory paradigm, emphasises the quantitative method used to gather data from a purposive sample with the use of a questionnaire. Data collected from 322 respondents revealed that the daily challenges, underpinned by a severe lack of funding at the selected public central hospitals in South Africa, inhibit high quality service delivery, making the public healthcare sector an undesirable option for medical tourism.

The impact of health on economic growth: A narrative literature review

The nexus between health and economic growth is a dynamic and complex relationship. This article reviews the empirical evidence that has sought to assess the causal impact of health on growth, understood as growth in GDP per capita, and focusing on cross-country and selected single country studies. The review largely provides evidence in favour of a positive effect of population health on economic growth. However, the multitude of the factors at play and the possible bidirectional relationship between health and growth pose a challenge for the quantification of the effect and for the relative importance of the underlying mechanisms.There is notable heterogeneity between studies in the magnitude and, in some cases, even in the sign of the effect. The evidence suggests that the health-growth relationship may depend on three main factors: the sample composition (i.e. a country's demographic stage or GDP per capita); the health dimension considered (e.g. health improvements at different life stages may affect productivity differently); and the model specification (e.g. whether or not initial life expectancy is controlled for in the analysis or the quality of the instrument).These findings advocate for a policy approach that integrates health considerations into economic strategies and emphasizes intersectoral collaboration to maximize the economic returns from improved health outcomes.

Youth, caregiver and healthcare professional perspectives on planning the implementation of a trauma-informed care programme: A qualitative study.

To explore youth, caregiver and staff perspectives on their vision of trauma-informed care, and to identify and understand potential considerations for the implementation of a trauma-informed care programme in an inpatient mental health unit within a paediatric hospital. We applied the Interpretive Description approach, guided by complexity theory and the Implementation Roadmap, and used Applied Thematic Analysis methods. Twenty-five individuals participated in individual or group interviews between March and June 2022, including 21 healthcare professionals, 3 youth and 1 caregiver. We identified two overarching themes. The first theme, 'Understanding and addressing the underlying reasons for distress', related to participants' understanding and vision of TIC in the current setting comprising: (a) 'Participants' understanding of TIC'; (b) 'Trauma screening and trauma processing within TIC'; (c) 'Taking "a more individualized approach"'; (d) 'Unit programming'; and (e) "Connecting to the community". The second theme, 'Factors that support or limit successful TIC implementation' comprises: (a) 'The need for a broad "cultural shift"'; (b) 'The physical environment on the unit'; and (c) 'Factors that may limit successful implementation'. We identified five key domains to consider within trauma-informed care implementation: (a) the centrality of engagement with youth, caregivers and staff in trauma-informed care delivery and implementation, (b) trauma-informed care core programme components, (c) factors that may support or limit success in implementing trauma-informed care within the mental health unit and (d) hospital-wide and (e) the importance of intersectoral collaboration (partnering with external organizations and sectors). When implementing TIC, there is an ongoing need to increase clarity regarding TIC interventions and implementation initiatives. Youth, caregiver and healthcare professional participants shared considerations important for planning the delivery and implementation of trauma-informed care in their setting. We identified five key domains to consider within trauma-informed care implementation: (a) the centrality of relational engagement, (b) trauma-informed care programme components, (c) factors that may support or limit successful implementation of trauma-informed care within the mental health unit and (d) hospital-wide and (e) the importance of intersectoral collaboration. Organizations wishing to implement trauma-informed care should consider ongoing engagement with all relevant knowledge user groups throughout the process. Standards for Reporting Qualitative Research (SRQR). The local hospital research institute's Patient and Family Advisory Committee reviewed the draft study methods and provided feedback.

Children's mental health promotion: The need for intersectorial and interprofessional collaboration

AbstractEvery moment counts (EMC) is a multi‐tiered mental health promotion initiative designed to build the capacity of practitioners to address the mental health needs of children and youth in school settings. This study evaluated the impact and cultural relevance of EMC workshops in supporting practitioners to apply a public health approach to children's mental health in Aotearoa New Zealand. A longitudinal mixed methods design employed a survey and semi‐structured interviews to evaluate the applicability, impact and cultural relevance of the EMC workshops. Themes identified from participants' reflections on their experiences of implementing EMC represented everyday practices at individual, team, and organizational levels. Specifically, intersectorial collaboration was perceived as beneficial. There is a call to action for practitioners to work more cohesively and interprofessionally, at policy and practice levels, to effectively promote children's mental health and achieve equitable health and well‐being outcomes. Communities of practice offer a potential mechanism to support translation of knowledge into practice in schools. Application of a public health approach to children's mental health in schools, facilitated by the EMC initiative, is applicable and positively impacts outcomes in Aotearoa New Zealand, with some modifications needed to better fit the cultural context.

Innovation in sport medicine and science: a global social network analysis of stakeholder collaboration in rugby union

ObjectivesTo investigate the network of stakeholders involved in rugby union research across the globe.MethodsUsing author affiliations listed on scientific publications, we identified the organisations that contributed to rugby union research...

Assessment of current child abuse policies in Saudi Arabia within the healthcare context: a comprehensive review

Background Global efforts to protect children from violence have been ongoing since the early 20th century. In Saudi Arabia, several policies were implemented to protect children from abuse and exploitation. Objective This review examines the current landscape of child abuse policies within the healthcare system of Saudi Arabia, evaluating the existing challenges and identifying areas for improvement. Methods This comprehensive review utilized multiple databases, including Google Scholar, Scopus, and PubMed, to identify articles relevant to child abuse, neglect, or adverse childhood experiences in Saudi Arabia. Moreover, Saudi Arabia’s governmental websites were reviewed to retrieve relevant laws and legislative documents. Results Several international agreements and domestic laws were implemented in Saudi Arabia, including the establishment of the National Family Safety Program (NFSP) (2005), Anti-trafficking in Persons Law (2009), Law for Protection from Abuse (2013), Child Protection Law (2014), Anti-Harassment Law (2018), and Juveniles’ Law (2018). Moreover, the Ministry of Human Resources and Social Development (MHRSD) oversees the implementation of these laws and provides support to abuse victims. However, despite existing legal frameworks, detecting and reporting child abuse cases in Saudi Arabia’s healthcare system faces challenges, including a lack of awareness, inadequate training, and the latest child abuse manual established in 2014. Conclusion While progress has been made, efforts are required by a multifaceted approach encompassing training healthcare providers, intersectoral collaboration, awareness campaigns, and developing a revised manual aligned with current laws in the Kingdom.

Roles of health system leadership under emergency in drought-affected districts in northeast Uganda: a mixed-method study

ObjectiveHealth system leadership plays a critical role in sustaining healthcare delivery during emergencies. Thus, we aimed to assess the contribution of health system leadership in sustaining healthcare delivery under emergency...

Strategies and recommendations to face respiratory syncytial virus disease in 2024

During the winter of 2023, Chile faced a complex situation related to the respiratory syncytial virus (RSV). After experiencing a decline in RSV circulation during the years of the SARS-CoV-2 pandemic, a late outbreak was observed in the spring of 2022 and an early onset of the outbreak in 2023, with a significant increase in the number of serious cases. The ineffectiveness of strategic planning and risk communication contributed to the complexity of the situation. To avoid the above next winter, measures such as active surveillance, unification of definitions for acute respiratory infections, identification of RSV variants, public education about infections and advance preparation regarding hospital beds and health personnel are suggested. The importance of immunization and intersectoral collaboration to acquire new preventive alternatives is highlighted, as well as the need for early communication about the importance of immunization and identification of high-risk groups, improvement in training of medical personnel and strategic planning of the Ministry of Health. seeking a proactive and collaborative approach to address the complex RSV situation in future winters. The Chilean Immunization Advisory Committee has already carried out an analysis and recommendation on a new prevention alternative. This working group will support any decision of the Ministry of Health in public policies that attempt a change in the paradigm of control of this disease for the health of the children of our country.

Generation Pep - study protocol for an intersectoral community-wide physical activity and healthy eating habits initiative for children and young people in Sweden.

There is overwhelming evidence for the preventive effects of regular physical activity and healthy eating habits on the risk for developing a non-communicable disease (NCD). Increasing attention has been paid to community-wide approaches in the battle against NCDs. Communities can create supportive policies, modify physical environments, and foster local stakeholder engagement through intersectoral collaboration to encourage communities to support healthy lifestyles. The Pep initiative is based on intersectoral community-wide collaboration among Sweden's municipalities. Primary targets are municipality professionals who work with children and young people as well as parents of children <18 years. The goal is to spread knowledge and create commitment to children's and young people's health with a special focus on physical activity and healthy eating habits to facilitate and support a healthy lifestyle. The overarching aim of the research project described in this study protocol is to investigate factors that influence the implementation of the Pep initiative in Sweden, to inform tailored implementation strategies addressing the needs and local prerequisites of the different municipalities. The project includes a qualitative and a quantitative study and is framed by a theoretical model involving four complementary forms of knowledge, explicitly recognized in the Pep initiative: knowledge about the issue; knowledge about interventions; knowledge about the context; and knowledge about implementation. Study 1 is a focus group study exploring barriers and facilitators for implementing the Pep initiative. The study will be carried out in six municipalities, selected purposively to provide wide variation in municipality characteristics, including population size and geographical location. Data will be analyzed using thematic analysis. Study 2 is a cross-sectional web-based survey investigating the implementability of the Pep initiative in Sweden's 290 municipalities. Conditions for implementing different areas of the Pep initiative will be examined in terms of the acceptability, appropriateness, and feasibility, three predictors of implementation success. Data will be analyzed using non-parametric statistics. The findings of the two studies will increase understanding of the prerequisites for implementing the Pep initiative in Swedish municipalities, which will provide valuable input into how implementation of the Pep initiative can best be facilitated in the different municipality settings.

Back to the roots of cause-related marketing – A systematic literature review of cooperation motives

Based on a systematic literature review, this paper explores the motives for cooperation between nonprofit organizations (NPO) and companies as profit organizations (PO) in the context of cause-related marketing (CrM) partnerships. CrM is a marketing and fundraising tool which combines the purchase of products with a “good cause” and has already gained significant attention in theory and practice as a widespread practice of corporate social responsibility. However, research often focuses on specific aspects and primarily on the perspective of consumers (i.e., their purchase or support intentions), while only a few studies deal with the motives that NPO and PO pursue with such intersectoral collaboration. Overall, the findings indicate that research on the NPO’s view is particularly limited and that CrM is generally based on a bundle of motives or (both financial and non-financial) goals, with the self-interested perspective of PO appearing to be dominant. The paper suggests several avenues for further research and advocates a stronger focus on fundamental questions that were raised decades ago but have not been adequately answered since the origins of CrM.

Undernutrition in children under five associated with wealth-related inequality in 24 low- and middle-income countries from 2017 to 2022

Undernourishment is a persistent public health problem contributing to increased mortality in children under five in low-income countries, likely exacerbated by socio-economic disparities within communities. This paper aimed to examine the effect of wealth-related inequality on undernutrition in children under five in low, lower-middle, and upper-middle-income countries (LMICs). We analyzed cross-sectional data from the demographic and health survey program collected between 2017 and 2022 from 24 LMICs. Children born within 5 years preceding the survey were included in the analysis. Child undernutrition was the dependent variable (measured by stunting, wasting, and underweight) and country-level wealth-based inequality was the independent variable assessed by concentration index values stratified by the World Bank’s income categories. Within country inequality of child undernutrition was determined by concentration index (C) values with 95% confidence intervals (95% CI) and sub-group analysis by place of residence and sex of the child. We then fit bootstrapped meta-regression to check the variation in inequality of child undernutrition across different income category countries. The analysis was controlled by potential confounding variables. From the total sample size of 334,502 children included in the study, 35% were undernourished. Wealth-related inequality in child undernutrition was observed in 11 countries, consistently across income categories. Child undernutrition was highly concentrated among the poor households of Türkiye [C: − 0.26, 95% CI − 0.31 to − 0.20], and Cameroon [C: − 0.19, 95% CI − 0.22 to − 0.17], and relatively it was less concentrated among the poor in Liberia [C: − 0.07, 95% CI − 0.11 to − 0.04], and Gambia [C: − 0.07, 95% CI − 0.11 to − 0.04]. There is no difference in undernutrition associated with inequality between the three broad LMIC categories. The wealth-related inequality in child undernutrition within many of the included countries is still very significant. However, the economic category of countries made no difference in explaining wealth-related inequality in child undernutrition. Inter-sectoral collaboration to fight poverty and render special attention to the disadvantaged population segments would potentially help to address the observed inequity.

How can intersectoral collaboration and action help improve the education, recruitment, and retention of the health and care workforce? Ascoping review.

Inadequate numbers, maldistribution, attrition, and inadequate skill-mix are widespread health and care workforce (HCWF) challenges. Intersectoral-inclusive of different government sectors, non-state actors, and the private sector-collaboration and action are foundational to the development of a responsive and sustainable HCWF. This review presents evidence on how to work across sectors to educate, recruit, and retain a sustainable HCWF, highlighting examples of the benefits and challenges of intersectoral collaboration. We carried out a scoping review of scientific and grey literature with inclusion criteria around intersectoral governance and mechanisms for the HCWF. A framework analysis to identify and collate factors linked to the education, recruitment, and retention of the HCWF was carried out. Fifty-six documents were included. We identified a wide array of recommendations for intersectoral activity to support the education, recruitment, and retention of the HCWF. For HCWF education: formalise intersectoral decision-making bodies; align HCWF education with population health needs; expand training capacity; engage and regulate private sector training; seek international training opportunities and support; and innovate in training by leveraging digital technologies. For HCWF recruitment: ensure there is intersectoral clarity and cooperation; ensure bilateral agreements are ethical; carry out data-informed recruitment; and learn from COVID-19 about mobilising the domestic workforce. For HCWF retention: innovate around available staff, especially where staff are scarce; improve working and employment conditions; and engage the private sector. Political will and commensurate investment must underscore any intersectoral collaboration for the HCWF.

Child and adolescent mental health services in Khartoum State, Sudan: a desktop situational analysis.

Sudan is a Northeast African country, with 61.7% of its population under 24 years. With a large youth population and significant cultural and linguistic diversity, Sudan, like most low-income countries, has contributed minimal data to global child and adolescent mental health (CAMH) research. This study aimed to perform the first ever situational analysis of CAMH services and systems in Khartoum State, Sudan. The study focused on Khartoum state and covered the calendar years 2019 and 2020. Using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) version 2.2 adapted for CAMH, the study focused on the publically available data sources. Findings were described and presented in tables and figures using the WHO-AIMS template. The situational analysis found no CAMH-specific policies, no separate budget for CAMH, and no supervising body for CAMH services in Khartoum. Three tertiary mental health hospitals provided CAMH services, all combined with adult mental health services. Essential medicines were available in all facilities, except methylphenidate available only in 3 central pharmacies. There was no free access to essential psychotropic drugs for children and adolescents except in emergency settings. Data about training to primary healthcare providers and the process of referral to specialized services were limited. A school mental health programme existed which provided early identification and management of CAMH problems in schools. The workforce was small and variable across all levels of care. No formal public health awareness campaigns and little evidence of formal intersectoral collaboration on CAMH were identified. A health information system existed, but no CAMH-specific items were reported. Among a handful of publications on CAMH, no national studies on CAMH were identified. This situational analysis represented the first systematic collation of data and information about CAMH in Sudan. Findings highlighted some areas of strength, but also many gaps in CAMH services and systems. We acknowledge the need to complement the desktop analysis with in-depth data collection with stakeholders across multiple levels, but hope that this will serve as a first step towards strengthening CAMH services in Sudan and other low-income countries.

Challenges and conditions for successfully implementing and adopting the telematics infrastructure in German outpatient healthcare: A qualitative study applying the NASSS framework.

Germany's healthcare system provides high-quality, universal health coverage to almost all residents. However, a major challenge lies in the strong separation of healthcare structures, which hinders efficient interprofessional and intersectoral communication and collaboration. The mandatory nationwide implementation of the telematics infrastructure may offer a solution to enhance healthcare professionals' communication and collaboration. Our study aims to elicit participants' perceptions of and attitudes towards the implementation and usage of the telematics infrastructure in fostering interprofessional communication and collaboration between home-care nursing services and general practitioner practices. We conducted interviews with seven members of general practitioner practices and 10 in home-care nursing services. Using thematic content analysis, we identified five themes, of which four along with 10 subthemes were integrated into Greenhalgh et al.'s 'nonadoption, abandonment, scale-up, spread and sustainability' framework. Participants recognised the potential of digital technology to enhance interprofessional communication and collaboration. However, this potential largely depended on individual healthcare actors' willingness to seek information, invest and adapt. Attitudes towards the telematics infrastructure varied widely from hopeful confidence to outright rejection. Home-care nursing services generally viewed the telematics infrastructure with optimism, while general practitioners expressed reservations, particularly due to technological disruptions, lack of user-friendliness, and organisational structures. Our findings highlight the potential of digital technology to enhance interprofessional communication. Successful implementation of technological innovations, however, goes beyond technological aspects and involves social, political and organisational processes. Future implementation strategies for such innovations in healthcare should involve users early and ensure clear communication.

Intersectorality in a conditional cash transfer programme: Actors, convergences and conflicts.

This study aimed to analyse intersectoral arrangements among the health, education and social assistance sectors in the operationalization of the Bolsa Família Program (BFP). A qualitative approach was carried out, in a peripheral region of a large urban centre of Southeast Brazil. Data content analysis was performed on the basis of reference in the Actor-Network Theory (ANT) using statements by the actors and considering ideas in dispute and work processes in the geopolitical territorial context. Seventeen managers of Municipal Secretariats of Health, Education and Social Assistance were interviewed, as were basic education, primary health care and social assistance professionals. One-off, episodic and discontinuous intersectoral actions were identified, with limited integration among sectors. Convergences and conflicts were found with respect to the institutional processes of BFP. The convergences referred to the conceptions shared among the actors about the role of intersectoral collaboration, as they recognize themselves as providing care to the same vulnerable population. Considering the multiple vulnerabilities of these families, the convergence of actions from different sectors can impact factors that condition inequalities. The conflicts were related to institutional conditions, to sectorized work processes and to a lack of understanding by professionals about the duties of their respective sectors.

School Health Nursing Based on Intersectoral Collaboration: A Proposal for Developing a Cost-Effective Model

Purpose: Although the importance of school healthservices is stated in laws and regulations, theabsence of regular, sustainable school healthservices has made it necessary to devise a newmodel for Turkey. With this project, creating amodel to promote school health nursing students inall schools in Turkey it is intended to providecontinuous school health services.Materials and Methods: All the students (6–11years) were included in the scope of this project (n= 1433). This project was conducted in anelementary school with a dense student populationin an area with internal and external migration andlow socioeconomic level. The duration of thisproject was from September 2016 to May 2019.Results: With the school health nursing modelbased on intersectoral cooperation, the necessarynursing care was provided in the health office, inaddition to students developing positive healthbehavior and health self-control (p &lt; 0.001), beingprovided the opportunity to diagnose importanthealth issues early, and gaining the awareness ofbeing responsible for their health.Conclusions: The use of this model of schoolhealth nursing services based on intersectoralcooperation in the provision of health services inschools will provide positive health outcomes. Inaddition, it is sustainable to use because it is costeffective.

Assessing capacities to strengthen intersectoral collaboration in Territorial Public Health Councils in the Republic of Moldova.

The government of the Republic of Moldova, endorsed the principle of Health in All Policies (HiAP) through its health sector reforms to address the rising burden of non-communicable diseases and health inequalities. Territorial Public Health Councils (TPHCs) were created to ensure the coordination and management of the population's health in their respective district. This study assessed the capacities of the TPHCs to identify areas in need of support for strengthening their intersectoral collaboration role in public health at local level. A mixed-method approach, using qualitative and quantitative techniques, was used to compare the perceptions of all TPHC members (n = 112) and invitees (n = 53) to council meetings from 10 districts covering all geographical areas of Moldova. The quantitative information was obtained using a cross-sectional survey, while the qualitative aspects were assessed within focus group discussions (FGDs). Half of all TPHC members, including 75% from groups with a non-medical background, did not attend a public health course within the last three years. Overall, groups with a medical background were more aware of the legislation that governs TPHC activity and intersectoral collaboration compared with those with a non-medical background. The FGDs of TPHC meetings revealed that members had an insufficient level of understanding of intersectoral collaboration to solve public health issues and lacked clarity about their place and role within the TPHC. HiAP implementation was found to be suboptimal with insufficient capacity at local level. TPHC members' ability to deal with public health issues were severely impaired by a general lack of knowledge and understanding of how to utilize the TPHC platform for maximum benefit. Reforming TPHC regulation is required in addition to extensive capacity building for TPHC members to increase member understanding of their roles as intended by TPHC regulations, including the facilitation of intersectoral collaborations.

Can Implementing New Services Organization Models to Better Meet the Needs of Young People Bring About Practice Changes? Analysis of an Experiment in Québec.

The research question addressed in this article is: Can implementing new services organization models to better meet the needs of young people bring about practice changes? More precisely, we examine the effects of a new model called Aire Ouverte (AO) which is implemented gradually across Quebec since 2019. This new model involves public sector and community organizations. To grasp practices' change, we use cultural historical activity theory (CHAT) and employ a qualitative approach. Beyond a precise description of work activities, we gained an inside view of how the actors involved represented their practice and context. Our results show that practice changes seen by actors are in line with the object of the intervention, that is, responding rapidly to the expressed needs of young people. The development of new tools, flexible functioning, strengthening of interprofessional and intersectoral collaboration, involvement of young people in decision-making, all should contribute to improving response to their needs. This being said, a critical look at practice changes reveals a challenge in aligning the design and objective of AO with the needs of some young people. We noted also a poor alignment of effective collaborative practices between levels of care and the practices sought from intersectoral collaboration.