Linking process and effects of intersectoral action on local neighbourhoods: systemic modelling based on Actor-Network Theory.

After 25 years of intersectoral practice to increase health promotion resources, there is little scientific literature linking analysis of processes to observation of effects. Applying Actor-Network Theory, this article examines how the effects of intersectoral action are produced and can be attributed to its processes. A prospective multiple case study (2013-2016) was conducted on Neighbourhood Committees (NCs) in Montreal (Canada). Three NCs were studied using four kinds of data: direct observation notes of meetings and events, documents, logbooks and interviews. Systemic modelling of local intersectoral action was used for data collection and analysis. The results show that the transformations in living environments were produced by sequences of a limited number of 'transitory outcomes' that mark the progression of intersectoral action up to its effects. The list of transitory outcomes identified make up three functions in the production of change: (i) network setup and governance; (ii) self-representing and influencing others; (iii) aligning necessary actors and resources. The production of effects follows a systemic model wherein unique configurations of transitory outcomes, adapted to the different contexts where interactions are occurring, represent the change processes that lead to the effects.

[Diagnostic tool for action in partnerships: foundation, development and validation]. / L'Outil diagnostique de l'action en partenariat: fondements, élaboration et validation.

OBJECTIVES: Intervening on social determinants of health requires that public health stakeholders enter into intersectoral partnerships. The lack of valid tools to evaluate the quality of partnerships is a significant constraint to formulating convincing arguments for this kind of action. In light of this shortcoming, the tool described in this article evaluates processes of collective action based on key aspects of its effectiveness. METHOD: The tool is based on a theoretical model that followed from case studies identifying the conditions associated with quality of partnerships. The tool was developed by operationalizing these conditions into a series of statements, and pretested using the cognitive interviewing method. Construct validity and ecological validity were verified. RESULTS: The tool includes 18 items, with 3 answer choices provided for each item. It is sensitive to variations in judgement. It allows for good convergence among respondents from participating organizations within a partnership; it can also distinguish between partnerships that have difficulty meeting certain conditions and those that do not. The tool is suitable for self-evaluation of partnerships engaged in common projects that involve more than information exchange. DISCUSSION: The tool's validity resides in its validation procedure and in the basic soundness of its theoretical model, which is supported by a number of literature reviews on how partnerships function and their results.

[The analysis of complex interventions in public health: the case of the prevention of sexually transmitted infections and blood-borne infections in Montreal]. / L'analyse des interventions complexes en santé publique : le cas de la prévention des ITSS à Montréal.

OBJECTIVES: Based on a theory of intervention as a complex action system, analyze collaboration among partners in Montréal's sexually transmitted and blood-borne infections (STBBI) prevention program to identify main operations problems and possible scenarios for change to achieve better outcomes. METHODS: A descriptive study was conducted using three data sources - public policies and programs, system management documents, and interviews with three types of partners. The results were validated with stakeholders. RESULTS: Five main operations problems affecting the capacity of the system to provide expected services were identified, as well as strategies the partners use to address these. CONCLUSION: Two scenarios for system change to increase its effectiveness in achieving program goals are discussed.