Évaluation du projet Hôpital promoteur de santé en contexte de périnatalité : analyse logique et analyse d’implantation

Problem: The concept of health promoting hospitals (HPH) emerged in the wake of the 1986 Ottawa Charter, which notably calls for the reorientation of health services toward more health promoting services. The concept targets the health of patients, staff, the community and the organization itself. In the context of Quebec’s health system reform that aims to bring services closer to the population and facilitates the journey of any person within a local network of health and social services (RLS), the adoption of the HPH concept appears to be a window of opportunity for teaching hospitals, now included in integrated university health care networks (RUIS) and linked to RLS, to carry out major organizational changes. Given the paucity of evidence regarding implementation of the different dimensions of HPH projects, there is a need for health care facilities to be accompanied in this process through the development of clear-cut strategies and practical tools in order to support implementation. Our study will focus on the first university hospital in Montreal that decided to adopt the concept and implement a HPH pilot project within its perinatal centre. Objectives: The objectives of this thesis are 1) to analyse the intervention theory underlying the HPH project; 2) to analyse the implementation of the HPH project; and 3) to explore the potential of developmental evaluation as a means of supporting the implementation process. Methods: To better understand the implementation of the HPS project, we opted for a qualitative case study. We first analyzed the theory of intervention by conducting a literature review in order to identify the characteristics of an HPS project as well as the conditions necessary for its implementation. Then, as regards the implementation analysis, our single case study had two methodological approaches: one to assess the level of implementation and the other to analyze facilitators and barriers to implementation. Finally, we explored the interest of using developmental evaluation to support the implementation process. Based on purposeful sampling, data of the case study were collected from key informants, HPH project promoters, managers, professionals and couples of patients directly concerned by the HPH project implementation in the perinatal centre. A documentary analysis of project documents has been done and participant observation was conducted in the setting. Results: The first article is about a logical analysis that presents the strengths and weaknesses of the implementation of the HPH project within the birthing centre, and offers a deeper comprehension of the factors likely to influence implementation. The second article assesses the level of implementation of the four dimensions of the HPH project. The complementarity of the different sources used allowed us to identify global successes, activities that were implemented only partially or still in the process of implementation, and activities that were based on an inadequate intervention theory. The third article shows the influence of intervention characteristics, outer and inner settings, and individual characteristics upon the implementation process, using the consolidated framework for implementation research developed by Damschroder et al. (2009). The fourth and final article highlights the challenges encountered by the researcher in attempting to use developmental evaluation, and puts forth solutions that will enable researchers to anticipate the difficulties that can emerge from integrating the demands of research and of utilization. Conclusion: This thesis contributes to the understanding of HPH project implementation in health care facilities, particularly within a perinatal care context. The results we have obtained are of interest to researchers as well as hospital or health care facility administrators who wish to implement or evaluate HPH projects.

Keyphrases: Health promoting hospital, developmental evaluation, intervention theory, implementation, maternity care, birthing center, birthing centre