Communities of Practice in Tobacco Control Cynthia Neilson, MA, BPHE

1. Communities of Practice in Tobacco Control Cynthia Neilson, MA, BPHE Irene Lambraki, PhD Health Promotion Specialist, Knowledge Transfer Senior Research Associate

2. Objectives Provide participants with an understanding of: • what CoPs are and why we use this model • how CoPs at PTCC function and have evolved • how we support CoPs • how we engage researchers • how we evaluate the CoPs and what we learned

3. Program Training and Consultation Centre • Resource Centre of the Smoke-Free Ontario Strategy since 1993 • Funded by Public Health Ontario • Strategic Priorities include: • Building capacity of 36 public health departments and organizations working in tobacco control in Ontario • Support moving evidence into action • Strengthen program development and applied research efforts • Build system capacity to support the Smoke Free Ontario Strategy renewal

4. Propel Centre for Population Health Impact • Propel is a collaborative enterprise with a mandate to conduct solution-oriented research and knowledge exchange to accelerate improvements in the health of populations. • Propel carries out the applied research of PTCC. Current initiatives involve conducting: • evidence-based reviews, evaluating interviews developed with the field, documenting practices from the field; and conducting a developmental evaluation to support the PTCC program • The Propel Centre for Population Health Impact at UW has been a PTCC partner since 2009.

5. What are Communities of Practice? • A group of people who: • share a concern, • a set of problems • passion about a topic • deepen their knowledge & expertise by interacting on an ongoing basis. Mechanism for learning, sharing and co-creating knowledge through fostering interdisciplinary and intersectoral relationships. (Wenger, McDermott & Snyder, 2002)

6. Why we implemented CoPs? • Smoke Free Ontario Strategy (SFO) - initiative of the Ministry of Health and Long-Term Care • To progress SFO, need invention and innovation – this is primarily generated from the field • PTCC instituted CoPs to support invention and innovation via provincial-level relationship building and knowledge exchange as a way to progress the SFO

7. Type of CoPs • PTCC hosts formally instituted CoPs that are externally funded and hosted by PTCC • Membership is voluntary • Priorities and activities are generated from membership

8. Purpose and Audience of CoPs • Purpose-to facilitate evidence-informed practice, knowledge exchange and cross-province communication among practitioners engaged in the Smoke-Free Ontario Strategy. Public Health CoP Members NGOs Researchers Government

9. CoPs at a Glance

10. How did PTCC decide on a CoP topic area?Domain • Originally consultations with public health practitioners (through Tobacco Control Area Network meetings - TCANs) • Consulted literature on other models (Garcia & Dorohovich, Wenger, etc.) Objectives of the Consultation: • To discuss the value of province-wide CoPs • To identify key content areas for province-wide CoPs • To determine the structure of CoPs and the products they desired to stimulate and support learning

11. Evolution of Topic Selection

12. Roles in a CoP • Members – individuals who provide meaningful contributions to the community • Subject Matter Experts –experienced members who can judge what is important, ground-breaking and useful to the group • Facilitator – foster and facilitate member interaction • Community Leader –guide the community’s purpose, intent, energizes the process (Garcia & Dorohovich, 2007)

13. Welcoming Members and CoP Growth • Initially, we invited 2 PH practitioners from each TCAN, as well as a handful of NGOs and researchers to form our CoP- this became the core membership • Our thoughts around membership have evolved • Field Support Staff at PTCC identify new members Public Health Units Field Support Staff Community of Practice

14. HOW- Practice • Host (bi-)monthly/monthly interactive webinars • 2 in-person meetings per year • Host an online community Members learn about and share: • Research and evaluation projects • Policy development opportunities • Social marketing/social media campaigns (prevention, protection, cessation) • Opportunities for collaboration • Lessons learned from practice • Helpful resources

15. Typical Monthly Webinar Agenda

16. Online Space

17. Community Charter and Learning Agenda

18. Evidence Summaries/Literature Reviews • Documents to help support/guide practitioners in making evidence informed decisions. Selected Topics: • Social marketing to influence young adults’ tobacco behaviour • Workplace tobacco cessation initiatives for young adults • Smoke-free beaches in Ontario: Progress and implications for practice • Compliance & enforcement of smoke-free outdoor spaces by-laws

19. Research Projects • No Butts About It- Propel & PTCC • Evidence-based workplace health promotion project to help workplaces in the retail sector offer a SF environment and offer employees support (esp. YAs) • TFSR Hockey Evaluation Study- OTRU & PTCC • Assess the impact of TFSR policies at the individual and community levels within ON hockey organizations and teams • Environmental Scan- YMCA & YWCA’s- Propel & PTCC • Understand the extent YMCA and YWCA locations in Ontario are enacting comprehensive tobacco-free policies that go beyond provincial laws or municipal by-laws

20. Documentations of Practice YA CoP • Choose To Be…Smoke-free: Peterborough County-City Health Unit’s Woman-CentredProgram TFSR & SF Outdoor Spaces CoP • The Development and Promotion of Guelph Soccer’s tobacco-Free Policy: Success Factors & Lessons • Partnerships Developed between Ontario’s Local Public Health Agencies & Ontario Hockey League Teams • Creating Smoke-Free Places: The Development of Smoke-Free outdoor Space By-Laws in Ontario DoPFull Reports: http://www.ptcc-cfc.on.ca/learn/DoPs/

21. Evaluation of the Communities of Practice Background Conceptual Framework Guiding the Study Purpose Methods Selected Results Summary Applying the Evaluation Findings

22. Background PTCC’s Communities of Practice (CoPs) are an important mechanism for provincial-level networking, knowledge exchange and innovation for the SFO A developmental and utilization-focused evaluation undertaken to understand how PTCC’s CoPs were developing and how they could be improved (Patton, 1994) Key stakeholders engaged:PTCC and Community of Practice (CoP) members

23. Our Thinking… Complex problems require complex solutions that get used (Best et al., 2009) Knowledge exchange, learning and integrating diverse perspectives are critical to generating these solutions Hard to do - requires different organizations and sectors with different values, ways of thinking and doing to work well together (Fiol et al., 2009, LeBaron, 2003)

24. Conceptual Framework

25. Purpose To examine: How PTCC’s CoPs were using knowledge gained from the CoP How PTCC’s CoPs were developing with respect to shared identity, member identification, social capital and psychological safety The importance of above concepts in CoP context and why The mechanisms or factors that CoP offers help to strength cohesion and knowledge use Member satisfaction with the CoP and areas of improvement The value add members gained by participating in the CoP

26. Methods Embedded case study design using mixed-methods (i.e., quantitative and qualitative methods) (Yin, 2009; Creswell et al., 2011) Phase IQuantitative Study (Online Survey) Assessed: member satisfaction, how CoPs were developing re: study, differences between the CoPs, relationships between concepts Phase IIQualitative Study (interviews, CoP documents) Phase I findings informed focus of Phase II and sample Data coded and analysed for common themes using NVivo 9 (Strauss & Corbin, 1990; Glaser & Strauss, 1967) 9

27. Characteristics of CoPs Examined

28. Phase I Study Sample 70 members across CoPs 35 of 56 eligible members completed survey (63% response rate) Eligibility criterion: Attended >1 meeting YA CoP 23 of 34 members 68% response rate TFSR CoP 12 of 22 members 55% response rate

29. Phase II Study Sample 14 members (subset of Phase I study) 7 YA CoP 7 TFSR CoP Sampled Diverse Perspectives: Varying levels of knowledge use (rarely, sometimes, often) Sectors Represented Roles Assumed in CoP Gender and Education

30. PHASE I: SELECTED RESULTS

31. Member Satisfaction General Trend TFSR CoP more satisfied than YA CoP for all of above aspects

32. Differences between CoPs TFSR CoP had consistently higher average ratings across all concepts assessed than YA CoP (i.e., they used CoP knowledge more, had stronger shared sense of identity, etc) • However only significant difference between TFSR CoP and YA CoP was based on shared identity and psychological safety

33. Relationships between Concepts and Knowledge Use Shared identity, member identification, social capital and psychological safety positively and significantly E.g., the more strongly shared the CoP identity the greater the social capital (or vice-versa) Shared identity, member identification, social capital and psychological safety each significantly related to knowledge use E.g., the more strongly shared the CoP identity, the more often knowledge gained from CoP would be used

34. PHASE II: SELECTED RESULTS

35. Knowledge Use Per CoP Both CoPs used knowledge in conceptual and instrumental ways Conceptual (sharing, increased awareness, learning with no immediate behaviour change) “most of my knowledge that I’ve learned about this area has come from this community of practice. So anything about how to start …policy…all the how-to’s, what campaigns seem to work…all that…” Instrumental (planning to use knowledge, making decisions, implementing changes) “(name of intervention), it had been evaluated and (when I took it) forward to management, I got an immediate ‘Yeah sure. Look into this and see if we can partner with them’” TFSR CoP more instances of instrumental knowledge use than YA CoP

36. Knowledge use: Areas for improvement YA CoP Greater access to researchers as area is under-researched and under-funded Move beyond discussing CoP knowledge to actual implementation: “there’s a show and tell kind of feel to teleconferences and not enough ‘let’s problem solve here. Let’s look at general strategies. What should be happening. Who could orchestrate that?’”

37. Shared Identity Shared understandings of what is ‘core’ and ‘distinctive’ about our CoP (Corley & Gioia, 2004) We’re inclusive A Common Purpose Presence/Lack We’re very local public health focused What we’re about aligns with my work We’re aligned with a broader movement We’re about knowledge sharing and learning We’re evidence-based Information/Knowledge We’re a Community of Practice We’re about the (CoP topic area)

38. Importance of Shared identity Facilitates Coherence: “Contributes to a more collaborative process” by “putting us all on the same page… so we all know what our purpose is of being here,” creating one shared voice… a synergy… so you’re really working towards something together” Facilitates Sense of Belonging and Member Participation Forms anchor point for member identification“…helps with building a sense of belonging to the group as well as a reason to attend meetings (because) if you catch people with what they’re…passionate about, they’ll likely be much more involved” Knowledge Use: “…if you’re in it for the same reasons, then I think you’re more committed and you’re going to share more and listen more attentively and so on…”

39. Shared Identity: Area(s) for Improvement YA CoP: “I feel somewhat disjointed in understanding exactly what we’re trying to accomplish.” Reason? Lack of Common Purpose “Well the TFSR CoP … there is a shared understanding (there) because those working actively in that CoP are all working with similar goals. They have the Public Health Standards, TSAG Report from the province telling (them they) must be working on this…They also have that provincial campaign to be working on…so they’re more action-based where ours has been more idea-based. So I think there has been more interest from this CoP to do the same because that’s what’s keeping them together and that’s what’s really working.”

40. Shared Identity: Area(s) for Improvement YA CoP lacked clarity about ‘who we are’ as a CoP because no clear government directives to guide them: “…I think the disconnect here is…how are we working in the context of what the Ministry of Health and Long-Term Care is doing…do we (as a CoP) espouse their philosophy?... We need to understand their perspective, direction…goals for young adult tobacco reduction if we’re to have any coordination…and it’s just sort of the elephant in the room. Nobody’s talking about it” TAKE AWAY: Need to create “alignment” between ‘who we are’ as CoP and mandates / priorities of key entities in broader system even when such mandates don’t exist

41. Member Identification and Importance “Who I am” is defined in part by “who we are” as a group, creating a sense of belonging (Ashforth & Mael, 1989) Contributes to development and strengthening of social capital: Enhances active participation and accountability to members: it makes you “feel motivated,” “more engaged,” and “some sense of obligation to work with people in the group,” and “you get better reception when you approach people to work with them on something” Knowledge Use: “When you feel that sense of belonging…you’re going to be more motivated to work. You’re going to feel like you’re a part of the CoP, and then you’re going to facilitate these initiatives out in your local community…and then the public will see the benefits as well”

42. Member Identification: Area(s) for Improvement • Non-local public health sector tended to have weaker sense of belonging to CoP • this detracted from their motivationtonetwork, actively participate or use CoP • knowledge because CoP knowledge wasn’t relevant to their sector’s needs • Why?Non-local public health sectors commonly defined CoPs as “very local public health focused,” which shaped focus of information that circulated in CoP • TAKE AWAY: • To encourage member identification and in turn motivation, create a shared identity that encompasses values and needs of their organizations/sectors

43. Social Capital • The features of social organization, such as networks, trust and norms of • reciprocity (Putnam, 1993) Some Key Findings: Members from both YA CoP and TFSR CoP made new connections with “members…across the province,” “in different health units,” and “beyond public health” Members also felt: • “comfortable” to contact other members, • co-members were trustworthy (i.e., benevolent- and competence-based trust), and • co-members were “…very receptive when you approach them for things”

44. Importance of Social Capital Empowerment: Networking and learning what others are doing and see “that the work that we are doing here (in our health unit) is very similar to work that’s been done around the province (increases) the comfort factor that yes, we’re on the right track…Let’s keep going down this road” Knowledge Use: “when you trust your coworkers and their opinions…you’re going to go to them for more information” and more likely of “giving their ideas a shot”

45. Social Capital: Area(s) for Improvement • Getting active participation from peripheral members or “lurkers” • was like “pulling teeth” • Why? • Technology: “with teleconference meetings, everyone is unseen….You’re vulnerable, you don’t know who is listening” • Level of Experience or % time spent at work on CoP topic area • Is it really so bad? ‘lurkers’ liked the flexibility the CoP offered • Take Home • Structure CoP so it allows multiple levels of participation to keep members connected and coming back

46. Key Mechanisms that Facilitate Cohesion and Knowledge Use • Knowledge • Access to relevant knowledge • Procedures • In-person meetings • Regular Meetings • Community Charter and Learning Agendas • Structures • Structured Time for Practice Sharing • Working Groups • Member Roles • Online Space • CoP Itself • People • PTCC • Members

47. Value Add for Members • “Awareness of what’s going on around the province” • ability to access evidence and resources via online space and members • “Networking” and “provincial-level relationships I didn’t have before” • “Creating linkages and having a greater impact by working together,” • “…Not reinventing the wheel” • CoP is a space that validates for members that they are on the right track with their initiatives • “Developed a level of expertise in content area that would not have had otherwise”

48. Summary Shared identity, member identification, social capital important to diverse members cohering in ways that enhance knowledge use Members from both CoPs satisfied with CoP, but TFSR CoP moreso TFSR CoP developing ‘better’ than YA CoP due to clear common purpose that aligned with priorities of government Several mechanisms contributed to development or strengthening of shared identity, sense of belonging, social capital and knowledge use

49. Applying the Evaluation Findings Confirmed that many of the activities or decisions we’ve made are working and should continue (e.g. in-person meetings, co-leader role, learning agenda, practice sharing, etc.) Created an online practice sharing Provide additional support for working groups Selected a new online platform Recruited additional researchers and created co-leader roles for them 49

50. References & Resources Related to CoPs Garcia, J., & Dorohovich, M. (2007). The truth about building and maintaining successful communities of practice. Defense Acquisition Journal Review, 12(1), 19-33. McDonald, P. & Viehbeck, S. (2007). From evidence-based practice making to practice-based evidence making: Creating communities of (research) and practice. Health Promotion Practice, 8(2), 140-144. Lambraki, I.A. (2012). Identity, Psychological Safety and Social Capital: A mixed methods examination of their influence on knowledge use in the context of LEARN Communities of Practice. Dissertation, University of Waterloo. http://hdl.handle.net/10012/7284 Nowaczek, A., Lambraki, I., Manske, S. (2010). Knowledge use among PTCC’s LEARN communities of practice: Tobacco use reduction for young adults and tobacco-free sport and recreation. Developmental evaluation of LEARN communities of practice. http://www.ptcc-cfc.on.ca/cms/one.aspx?pageId=100781 Wenger, E., McDermott, R. & Snyder, W. (2002). A guide to managing knowledge: Cultivating communities of practice. Boston, Massachusetts: Harvard Business School Press. CP Squared - “The Community of Practice on Communities of Practice” http://cpsquare.org/ Program Training and Consultation Centre, LEARN Project. CoP reading and resource list. http://www.ptcc-cfc.on.ca/common/pages/UserFile.aspx?fileId=103912 50