Promotion of Physical Activity by Québec Primary Care Physicians: What Has Changed in the Last Decade?

OBJECTIVE: This study aimed to assess the changes in the frequency of physical activity (PA) counseling and in the predictors of primary care PA promotion in Québec primary care physicians (PCPs) between 2010 and 2020. METHODS: In 2010, we conducted a survey among Québec PCPs. Questions included: frequency of promoting PA to patients, perceived barriers, needs to improve PA promotion practice, frequency of PCPs' PA practice, and sociodemographic information. In 2020, we took over the 2010 questionnaire to document the evolution of the PA promotion practice. RESULTS: The proportion of PCPs discussing PA with their patients significantly increased (P < .05) in 2020 for the following health conditions: depression, low back pain, chronic obstructive pulmonary disease, and cancer; it declined (P < .05) for overweight patients, those with metabolic syndrome, and in primary prevention. Collaboration with PA professionals was the major need identified, and it increased in 2020. PCPs' own practice of PA was a predictor of PA promotion in 2010 (odds ratio = 6.679; P < .001) and in 2020 (odds ratio = 6.679; P < .001). In both 2010 and in 2020, older or more experienced PCPs were more likely to discuss PA with their patients without diagnosed diseases than younger ones or those with less experience. CONCLUSIONS: Over the last 10 years, there has been a significant increase in PCPs promoting PA in Québec; however, it has been mainly oriented toward secondary prevention. It is concerning that PA counseling in primary prevention has declined, notably among younger PCPs. The stronger claim for closer collaboration with kinesiologists suggests that PCPs are in favor of an interprofessional strategy, namely collaboration with PA specialists.

Activate Your Health: impact of a real-life programme promoting healthy lifestyle habits in Canadian workers.

The workplace has been suggested as a good setting for the promotion of healthy lifestyles. This article examines the impact of Activate Your Health programme, provided over an average of 1.35 years, on employee health and lifestyle habits (actual and intention to improve). Companies selected one of the programme's four options (number of interventions in parentheses): Control (2), Light (8), Moderate (13) and High (14). Employees (n = 524) completed an online questionnaire at baseline and post-intervention. Mixed-effect models and generalized estimating equations models were used, where appropriate. There was an interaction effect of time by option for the number of employees intending to improve sleep habits (p = 0.030): +11.0% in Light (p = 0.013). No significant interaction effect of time by option was observed for body weight, body mass index, number of health problems or lifestyle habits (actual and intention to improve). When stratified by sex, there was an interaction effect of time by option for the number of women intending to improve sleep habits (p = 0.023): -26.1% in Moderate (p = 0.014). There was an interaction effect of time by option for body weight in men (p = 0.001): -0.58 kg in High (p = 0.031) and +2.58 kg in Control (p = 0.005). Other outcomes of interest were stable or improved post-intervention, regardless of option. The Activate Your Health programme allowed employees to maintain or improve outcomes related to health and lifestyle habits. A package like High may be beneficial for body weight regulation in men.

An evaluation of the 'bottom-up' implementation of the Active at school! programme in Quebec, Canada.

The lack of physical activity (PA) amongst children is a public health concern in many industrialized countries. School-based daily physical activity (DPA) policies are a promising intervention for increasing PA levels amongst children. Informed by a logic model framework, this study examines the factors associated with meeting a 'top-down' DPA objective in the context of a 'bottom-up' implementation of a school-based DPA initiative in Quebec, Canada. An online survey assessing school-level inputs, outputs and outcomes was sent to all participating schools (415). Crude odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression to evaluate potential associations between factors (inputs and outputs) and the school's adherence to providing at least 60 minutes of DPA (outcome). Adjusted ORs (AORs) and 95% CIs were calculated using a multivariate logistic regression to identify the best set of factors to predict adherence to the DPA objective. A total of 404 schools completed the questionnaire, amongst which 71% reported meeting the DPA target by implementing school-tailored activities. Three factors were identified as the best set of school inputs and outputs to predict meeting the objective: financial resources (per student) (AOR = 1.02; 95% CI 1.01-1.03), a shared vision amongst the school-team members that PA benefits learning outcomes (AOR = 1.94; 95% CI 1.04-3.19) and having conducted a detailed situational analysis (AOR = 1.89; 95% CI 1.00-3.58). Given that 'bottom-up' implementation might favour the development of policies that are more acceptable to stakeholders, our results should be considered by decision-makers and school administrators when implementing DPA initiatives.

The lack of physical activity (PA) amongst children is a public health concern in many industrialized countries. School-based daily physical activity (DPA) policies are a promising intervention for increasing PA levels amongst children. The primary purpose of this study was to examine the school-level factors of Quebec's Active at school! initiative, whose goal was to encourage elementary school teams to develop and implement tailored mobilizing strategies and activities for providing 60 minutes of DPA to their students. Our results suggest that the school team's perception of PA benefits on learning outcomes, the financial resources (per student) provided to the school, and a locally conducted situational analysis at the beginning of the implementation process are significant predictors of meeting the DPA objective. The secondary aim of our study was to explore whether the factors were different according to the geographical setting of the schools. Conducting a situational analysis was shown to be of particular importance for urban schools but did not seem to play a pivotal role for rural schools, suggesting that different organizational culture and population characteristics may be at work when implementing a bottom-up initiative in these two contexts.

Do the implementation processes of a school-based daily physical activity (DPA) program vary according to the socioeconomic context of the schools? a realist evaluation of the Active at school program.

BACKGROUND: Less than half of Canadian children meet the Canadian Physical Activity (PA) Guidelines, and the proportion is even lower among children living in underprivileged neighbourhoods. Regular PA supports physical, cognitive, and psychological/social health among school-aged children. Successful implementation of school-based daily physical activity (DPA) programs is therefore important for all children and crucial for children who attend schools in lower socioeconomic settings. The purpose of this study is to uncover what worked, for whom, how, and why during the three-year implementation period of a new "flexible" DPA program, while paying particular attention to the socioeconomic setting of the participating schools. METHODS: This study is a realist evaluation using mixed methods for data generation. Longitudinal data were collected in 415 schools once a year during the three-year implementation period of the program using questionnaires. Data analysis was completed in three steps and included qualitative thematic analysis using a mixed inductive and deductive method and chi-square tests to test and refine context-mechanism-outcome (CMO) configurations. RESULTS: Giving the school teams autonomy in the choice of strategies appropriate to their context have allowed schools to take ownership of program implementation by activating a community empowerment process, which resulted in a cultural shift towards a sustainable DPA provision in most settings. In rural underprivileged settings, the mobilization of local resources seems to have successfully created the conditions necessary for implementing and maintaining changes in practice. In disadvantaged urban settings, implementing local leadership structures (leader, committee, and meetings) provided pivotal assistance to members of the school teams in providing new DPA opportunities. However, without continued external funding, those schools seem unable to support local leadership structures on their own, jeopardizing the sustainability of the program for children living in disadvantaged urban areas. CONCLUSION: By exploring CMO configurations, we have been able to better understand what worked, for whom, how and why during the three-year implementation period of the Active at School! PROGRAM: When implementing DPA policies, decision makers should consider adjusting resource allocations to meet the actual needs of schools from different backgrounds to promote equal PA opportunities for all children.

Improvement Predictors in a Workplace Program Promoting Healthy Lifestyle Habits.

BACKGROUND: The baseline characteristics of employees to predict improvements in healthy lifestyle habits (LHs) following workplace health promotion programs are underexplored. This study sought to identify predictors of improvements in physical activity (PA), eating habits, sleep habits, and stress management, and health risk factors resulting from healthy LHs. METHODS: The Activate Your Health program included 3 packages of an increasing number of interventions: light, moderate, and high. Participating employees (n = 506) completed baseline and postintervention questionnaires that collected sociodemographic data, health- and LH-related variables, stress-related variables, and perceptions of general health and life satisfaction. Only those with the potential to improve were included in each improvement outcome analysis. RESULTS: Being in high and intending to reduce alcohol consumption increased the odds of improving PA. Very good/excellent perceived general health, poor sleep habits, high alcohol consumption, and intending to improve stress management increased the odds of improving stress levels at work. Depression and intending to improve sleep habits increased the odds of improving stress management. Reporting feelings of pleasure increased the odds of improving body mass index. CONCLUSIONS: Baseline characteristics predicting improvements differed for each LH. A targeted approach may be needed to help employees improve LHs and related outcomes.

Barriers to cross-disciplinary knowledge flow: The case of medical education research.

INTRODUCTION: The medical education research field operates at the crossroads of two distinct academic worlds: higher education and medicine. As such, this field provides a unique opportunity to explore new forms of cross-disciplinary knowledge exchange. METHODS: Cross-disciplinary knowledge flow in medical education research was examined by looking at citation patterns in the five journals with the highest impact factor in 2017. To grasp the specificities of the knowledge flow in medical education, the field of higher education was used as a comparator. In total, 2031 citations from 64 medical education and 41 higher education articles published in 2017 were examined. RESULTS: Medical education researchers draw on a narrower range of knowledge communities than their peers in higher education. Medical education researchers predominantly cite articles published in health and medical education journals (80% of all citations), and to a lesser extent, articles published in education and social science journals. In higher education, while the largest share of the cited literature is internal to the domain (36%), researchers cite literature from across the social science spectrum. Findings suggest that higher education scholars engage in conversations with academics from a broader range of communities and perspectives than their medical education colleagues. DISCUSSION: Using Pierre Bourdieu's concepts of doxa and field, it is argued that the variety of epistemic cultures entering the higher education research space contributes to its interdisciplinary nature. Conversely, the existence of a relatively homogeneous epistemic culture in medicine potentially impedes cross-disciplinary knowledge exchange.

Health-Related and Lifestyle Factors as Predictors of Intentions to Improve Lifestyle Habits in Employees Participating in a Workplace Health Promotion Program.

OBJECTIVES: To explore employees' intentions to improve lifestyle habits, investigate the health and lifestyle-related predictors of these intentions, and how it translated into behavioral improvement. METHODS: Employees participating in the Activate Your Health WHPP completed a questionnaire of their demographics, health-related variables, as well as six lifestyle habits and intention to improve them. RESULTS: At baseline (n = 2729), most employees wanted to focus on physical activity and eating habits. Many predictors were identified for each intention. Majority of intentions were associated with behavioral improvement post-program (n = 525), especially in High. CONCLUSIONS: In the context of WHPPs, intention to improve may lead to actual behavioral improvement. Exploring employees' intentions to improve various lifestyle habits at the start of the program could improve the effectiveness of these programs.

Can school-based physical activity foster social mobility?

Social mobility refers to the intergenerational transmission of socio-economic status, and therefore of health status. Hence, it is important to consider social mobility to tackle the social gradient in health in the long term. Fostering social mobility requires developing public policies that ensure equal opportunities for all children. The intent of this commentary is to illustrate how a proportionate universalism approach to school-based physical activity could be a way to promote equal opportunity for children within the school environment. Alberta's Daily Physical Activity policy and the APPLE Schools program are used to illustrate this approach: these two programs not only create enabling environments that can support children in adopting healthy lifestyles but also contribute to the reduction of social inequalities in physical activity by fostering capacity building.

RéSUMé: La mobilité sociale fait référence à la transmission intergénérationnelle du statut socio-économique et, par conséquent, de l'état de santé. Il est donc important de considérer la mobilité sociale dans l'action publique visant à atténuer le gradient social de santé à long terme. Favoriser la mobilité sociale nécessite d'élaborer des politiques publiques propres à assurer l'égalité des chances pour tous les enfants afin qu'ils aient la possibilité d'améliorer leur sort. Ce commentaire vise à illustrer comment une approche universelle proportionnée de promotion de l'activité physique en milieu scolaire pourrait être un moyen de promouvoir l'égalité des chances en éducation. La politique d'activités physiques quotidienne de l'Alberta et le programme APPLE Schools sont utilisés pour illustrer cette approche : ces deux programmes créent non seulement des environnements favorables à l'adoption d'un mode de vie sain pour les enfants, mais contribuent également, à travers un processus de renforcement des capacités, à la réduction des inégalités sociales en matière d'activité physique.

Socioeconomic and gender-based disparities in the motor competence of school-age children.

This study examined socioeconomic and gender-based disparities in motor competence (MC) amongst 6-12-year-old children (N = 2654). Validated product-oriented tests assessing agility, balance and coordination were used to measure MC. School-level socioeconomic status (low, middle, high) was used to assess socioeconomic disparities. Analysis of covariance (ANCOVA) were conducted and odds ratios were calculated for the likelihood of having low MC by gender and socioeconomic status (SES). Girls displayed lower MC than boys for agility and coordination involving object-control (P < 0.001) while boys scored lower than girls for balance and hand-foot coordination (P < 0.001). Children in high SES schools displayed the highest level of MC for agility, balance and coordination (P < 0.001). Compared to the children in high SES schools, odds of having low competence in balance was higher for the children in low SES schools and odds of having low competence in agility and coordination were higher for the children in both low and middle SES schools. Newell's model of constraints (1986) and Bourdieu's concept of habitus (1984) were used to consider potential explanations of the observed disparities. To level up inequalities in children's MC, resources invested in school-based interventions should be proportionate to the school SES.

Interdisciplinarity in medical education research: myth and reality.

The medical education (Med Ed) research community characterises itself as drawing on the insights, methods, and knowledge from multiple disciplines and research domains (e.g. Sociology, Anthropology, Education, Humanities, Psychology). This common view of Med Ed research is echoed and reinforced by the narrative used by leading Med Ed departments and research centres to describe their activities as "interdisciplinary." Bibliometrics offers an effective method of investigating scholarly communication to determine what knowledge is valued, recognized, and utilized. By empirically examining whether knowledge production in Med Ed research draws from multiple disciplines and research areas, or whether it primarily draws on the knowledge generated internally within the field of Med Ed, this article explores whether the characterisation of Med Ed research as interdisciplinary is substantiated. A citation analysis of 1412 references from research articles published in 2017 in the top five Med Ed journals was undertaken. A typology of six knowledge clusters was inductively developed. Findings show that the field of Med Ed research draws predominantly from two knowledge clusters: the Applied Health Research cluster (made of clinical and health services research), which represents 41% of the references, and the Med Ed research cluster, which represents 40% of the references. These two clusters cover 81% of all references in our sample, leaving 19% distributed among the other knowledge clusters (i.e., Education, disciplinary, interdisciplinary and topic centered research). The quasi-hegemonic position held by the Applied Health and Med Ed research clusters confines the other sources of knowledge to a peripheral role within the Med Ed research field. Our findings suggest that the assumption that Med Ed research is an interdisciplinary field is not convincingly supported by empirical data and that the knowledge entering Med Ed comes mostly from the health research domain.

Social return on investment (SROI) method to evaluate physical activity and sport interventions: a systematic review.

BACKGROUND: Physical Activity and Sport (PAS) interventions can reduce the social and economic burden of non-communicable diseases and improve the wellbeing of the population. Social return on investment (SROI) has the capacity to measure broader socio-economic outcomes in a singular monetary ratio to help identify the most impactful and cost-beneficial intervention. This review aimed to systematically identify and review studies using the SROI method within the field of PAS and assess their quality. METHODS: Peer-reviewed and grey literature SROI studies were identified through a systematic search of six databases. Two reviewers independently assessed the identified studies to determine eligibility. Study quality was assessed using the Krelv et al. 12-point framework. For each included study, information was extracted and classified into summary tables. Extracted information included study and participant characteristics, type of outcomes and SROI ratio. The PRISMA guidelines were followed. RESULTS: Seventeen studies published between 2010 and 2018 met the inclusion criteria. Most studies (94%) were non-peer reviewed publicly available reports, primarily conducted in the UK (76%), by private consulting firms (41%) and included all types of stakeholders (76%). PAS interventions included Primary prevention (47%), Sport for development (29%), Secondary and tertiary prevention (18%) and High-performance sport (6%). SROI ratios, which report the social value created in relation to the cost of an intervention, vary between 3:1 and 124:1 for the high-quality studies. CONCLUSIONS: The SROI framework can be a useful tool to inform policy-making relating to PAS investment as it can account for the wide societal benefits of PAS. The quality of studies in the field would benefit from the employment of an impact map (or logic model), reporting negative outcomes and using objective study designs. The application of the SROI method in the PAS field is relatively recent, and thus further research would be beneficial to promote its potential for policy-making bodies in the field.

Problematizing assumptions about interdisciplinary research: implications for health professions education research.

This article critically examines three assumptions underlying recent efforts to advance interdisciplinary research-defined in this article as communication and collaboration between researchers across academic disciplines (e.g. Sociology, Psychology, Biology)-and examines these assumptions' implications for health professions education research (HPER). These assumptions are: (1) disciplines are silos that inhibit the free flowing of knowledge across fields and stifle innovative thinking; (2) interdisciplinary research generates a better understanding of the world as it brings together researchers from various fields of expertise capable of tackling complex problems; and (3) interdisciplinary research reduces fragmentation across groups of researchers by eliminating boundaries. These assumptions are among the new beliefs shaping the contemporary academic arena; they orient academics' and university administrators' decisions toward expanding interdisciplinary research and training, but without solid empirical evidence. This article argues that the field of HPER has largely adopted the premises of interdisciplinary research but has not yet debated the potential effects of organizing around these premises. The authors hope to inspire members of the HPER community to critically examine the ubiquitous discourse promoting interdisciplinarity, and engage in reflection about the future of the field informed by evidence rather than by unsubstantiated assumptions. For example: Should research centres and graduate programs in HPER encourage the development of interdisciplinary or disciplinary-trained researchers? Should training predominantly focus on methods and methodologies or draw more on disciplinary-based knowledge? What is the best route toward increasing the field's profile within academia and attracting the best students and researchers to engage in HPER? These are questions that merit attention at the current juncture as the future of the HPER field relies on decisions made in the present time.

Activate Your Health, a 3-year, multi-site, workplace healthy lifestyle promotion program: study design.

BACKGROUND: Workplace Health Promotion Programs (WHPP) have been shown to be an efficient way of improving workers' health. These programs can be incorporated in the worker's daily schedule and improve their productivity at work. Improving employees' health also benefits the employers by increasing their return on investment and lowering healthcare costs. The Activate Your Health program, created by Capsana in 2015, is a WHPP targeting multiple lifestyle habits for a three-year period. This WHPP includes tailored web-based interventions and the support of different health professionals throughout the years. We hypothesize that this approach will yield long-term lifestyle changes. The objective of the current paper is to describe the Activate Your Health program's design. METHODS/DESIGN: Eleven companies are taking part in this WHPP and had to choose among five different options of this program and all their employees were encouraged to participate. Each option differs by the number and type of interventions included. The limited option, which is considered the control group, only consists in completing a questionnaire regarding their health status, lifestyle habits and behaviors. On the other end, the extensive option receives a combination of multiple interventions: online menus, health challenges, support in creating a healthy work environment, coaching by health professionals (nurse, nutritionist, and kinesiologist), health screening and flexibility assessment, online resources, social health platform, and activity tracking. The remaining options are in between these options and vary by the amount of intervention. Baseline data are already gathered; two other data collection periods will take place after one and 2 years into the program. The primary outcomes of the current program are physical activity and fitness measures, nutritional data, smoking habits, stress and intention to change. DISCUSSION: The Activate Your Health program will allow us to compare which combinations of interventions are the most effective. It is expected that the extensive option will be the most advantageous to improve lifestyle habits. The results will indicate the strength and weakness of each intervention and how it could be improved. TRIAL REGISTRATION: Clinicaltrails.gov, registration number: NCT02933385 (updated on the 26th of March 2019, initially registered on the 5th of October 2016).

Examining grounded theory through the lens of rationalist epistemology.

The objective of scientific, or more broadly, academic knowledge is to provide an understanding of the social and natural world that lies beyond common sense and everyday thinking. Academics use an array of techniques, methods and conceptual apparatuses to achieve this goal. The question we explore in this essay is the following: Does the grounded theory approach, in the constructivist version developed by Kathy Charmaz, provide the necessary methodological tools for the creation of knowledge and theories beyond everyday thinking? To conduct our analysis, we have drawn on the rationalist epistemology originally developed by Gaston Bachelard and taken up a few decades later by Pierre Bourdieu and colleagues to look at the epistemological foundation of the CGT methods as defined by Charmaz. We focussed on two distinctive epistemological features characterising constructivist grounded theory (CGT): the use of inductive reasoning to generate interpretative theory; and the primacy of subjectivity over objectivity as the preferred path to knowledge making. While the usefulness of CGT for conducting qualitative research and understanding the perspective of social actors has been acknowledged by scholars in health professions education research and other research areas, the inductivist logic on which it draws raises questions concerning the nature of the knowledge yielded by this approach. As we argue in this article, it is still unclear in what way the interpretative theory generated by CGT is not a duplication of everyday thinking expressed through meta-narratives. It is also unclear how the understanding of social phenomena can be refined if the use of inductive procedures logically implies the creation of a new theory each time a study is conducted. We engage with these questions to broaden the epistemological conversation within the health professions education research community. It is our hope that scholars in the field will engage in this epistemological conversation and advance it in new directions.

Confined to a tokenistic status: Social scientists in leadership roles in a national health research funding agency.

The idea of interdisciplinarity has been taken up by academic and governmental organisations around the world and enacted through science policies, funding programs and higher education institutions. In Canada, interdisciplinarity led to a major transformation in health research funding. In 2000, the federal government closed the Medical Research Council (MRC) and created the Canadian Institutes of Health Research (CIHR). From the outset, CIHR's vision and goals were innovative, as it sought to include the social sciences within its purview alongside more traditional health research sectors. The extent to which it has been successful in this endeavour, however, remains unknown. The aim of our study was to examine how CIHR's intentions to foster inclusiveness and cooperation across disciplines were implemented in the agency's own organisational structure. We focused on social scientists' representation on committees and among decision-makers between 2000 and 2015, one of the key mandates of CIHR being to include the social sciences within its remit and support research in this area. We examined the composition of the Governing Council, the Institute Scientific Directors, the Chairs of the College of Reviewers, and two International Review Panels invited by CIHR. We targeted these committees and decision-makers since they hold the power to influence the field of Canadian health research through the decisions they make. Our findings show that, while CIHR was created with the mandate to support the entire spectrum of health-related research-including the social sciences-this call for inclusiveness has not yet been materialized in the agency's organisational structure. Social scientists, as well as researchers from neighbouring disciplines such as social epidemiology, health promotion and the humanities, are still confined to low levels of representation within CIHR's highest echelons. This imbalance limits social scientists' input into health research in Canada and undermines CIHR's interdisciplinary ambition.

Effects of a culturally tailored physical activity promotion program on selected self-regulation skills and attitudes in adolescents of an underserved, multiethnic milieu.

PURPOSE: To implement a culturally tailored physical activity (PA) promotion program (FunAction) and to assess its impact on five self-regulation skills and attitudes in adolescents. Design . The design and implementation of the FunAction program were informed by social marketing principles. The study used a quasi-experimental approach to assess the impact of the program on specific outcome variables. SETTING: A multiethnic, underserved middle school in Montreal, Quebec, Canada. SUBJECTS: The intervention group was made up of grade 8 students (n  =  165) and the control group was made up of grade 7 students (n  =  137). INTERVENTION: During the 16-week intervention, adolescents were able to choose from a variety of 45-minute cardiovascular PAs offered daily during their school lunch period. Adolescents participated in the activities on a voluntary basis. MEASURES: A self-report questionnaire was administered preintervention and postintervention to measure adolescents' scores on the following self-regulation skills and attitudes: self-control, self-esteem, attention/concentration, social competence, and interethnic relationships. ANALYSIS: Three-way repeated measures analyses of variance and correlational analyses were used. Results . A significant improvement was observed only in attention/concentration. Girls' attention/concentration scores improved significantly in the intervention group compared to the control group (F(1,127)  =  16.26, p < .001). The improvement in attention/concentration scores for boys in the intervention group was correlated with their frequency of participation in the program PAs (r  =  .24, p  =  .008). CONCLUSION: Using social marketing principles can help encourage adolescents from underserved, multiethnic milieus to participate in PA during their school lunch hour. Furthermore, voluntary participation in a culturally tailored PA program can improve youths' attention/concentration.

How divergent conceptions among health and education stakeholders influence the dissemination of healthy schools in Quebec.

This paper focuses on dissemination of the healthy schools (HS) approach in the province of Quebec, Canada. Dissemination aims at raising awareness about HS and promoting its adhesion among actors concerned with youth health in school. As HS is a joint initiative based on agreement and collaboration between health and educational sectors, the positions of stakeholders that foster cooperation between these sectors were considered to be critical to optimize its dissemination. The study's objectives were to: (i) examine and contrast the stakeholders' conceptions of HS and (ii) understand how converging and diverging stakeholders' positions on HS favourably or negatively influence its dissemination in Quebec. Gray's analytical approach to collaboration and its focus on stakeholders' mindframe about a domain served as a conceptual lens to examine stakeholders' positions regarding HS. Collection methods included documentary analysis and semi-structured interviews of 34 key internal and external informants at the provincial, regional and local levels. The results showed consensual adhesion to fundamental principles of the HS approach. However, differences in conceptualization between provincial authorities of the two sectors concerning the way to disseminate HS have been observed. These differences represented a significant barrier to HS optimal dissemination. A dialogue between the two authorities appears to be essential to arrive at a negotiated and shared conceptualization of this issue in the Quebec context, thus allowing agreements for adequate support. The results may serve as the basis for a more fruitful dialogue between actors from the two sectors, at different administrative levels.

Physical activity promotion among underserved adolescents: "make it fun, easy, and popular".

There is a paucity of studies regarding noncurricular physical activity promotion interventions among adolescents, and even less such research pertaining to underserved youth. This article describes the development and implementation of a noncurricular, school-based physical activity promotion program designed for a multiethnic, underserved population of adolescents. The program's impact on leisure-time physical activity (LTPA) and on physical activity enjoyment (PAE) is also presented. The 16-week program, named FunAction, utilizes social marketing principles. Control (n = 90) and intervention (n = 131) students are assessed pre- and postintervention for levels of LTPA and PAE. Results indicate that although the program did not contribute to an increase in LTPA or PAE among intervention group students, participation in the program was elevated. This study offers preliminary evidence that noncurricular physical activity promotion programs that apply social marketing principles can be effective in engaging multiethnic, underserved adolescents in physical activity.

Perspectives of clinician and biomedical scientists on interdisciplinary health research.

BACKGROUND: Interdisciplinary health research is a priority of many funding agencies. We surveyed clinician and biomedical scientists about their views on the value and funding of interdisciplinary health research. METHODS: We conducted semistructured interviews with 31 biomedical and 30 clinician scientists. The scientists were selected from the 2000-2006 membership lists of peer-review committees of the Canadian Institutes of Health Research. We investigated respondents' perspectives on the assumption that collaboration across disciplines adds value to health research. We also investigated their perspectives on funding agencies' growing support of interdisciplinary research. RESULTS: The 61 respondents expressed a wide variety of perspectives on the value of interdisciplinary health research, ranging from full agreement (22) to complete disagreement (11) that it adds value; many presented qualified viewpoints (28). More than one-quarter viewed funding agencies' growing support of interdisciplinary research as appropriate. Most (44) felt that the level of support was unwarranted. Arguments included the belief that current support leads to the creation of artificial teams and that a top-down process of imposing interdisciplinary structures on teams constrains scientists' freedom. On both issues we found contrasting trends between the clinician and the biomedical scientists. INTERPRETATION: Despite having some positive views about the value of interdisciplinary research, scientists, especially biomedical scientists, expressed reservations about the growing support of interdisciplinary research.