II Key Findings
III Discussion and Concluding Statement
--Submitted by Irene Lambraki, Kalpita Gaitonde and Karen Pieters
Great strides have been made in tobacco control, yet tobacco use continues to be a major cause of preventable death and disease in Canada.  Multiple factors, such as people’s biology, behaviours, and the environments in which they live, make tobacco control efforts a challenging undertaking. Different sectors need to work together to develop programs and policies that address these factors while also ensuring these initiatives fit the unique cultural, social, and political characteristics of the settings in which they are implemented.  Finding ways to bring public health practitioners, researchers and policy makers together to share what they know, build on what has worked in the past, and develop innovative solutions is critical to the progress of tobacco control. Communities of practice (CoPs) are one mechanism that can facilitate this work. 
What are Communities of Practice?
CoPs are groups of people who share a concern, a set of problems, or a passion for something they do and learn how to do it better as they interact regularly.  CoPs have gained attention from scholars and practitioners as mechanisms that can help to improve practice and performance. [4–7] While CoPs often evolve informally, they can also be formally instituted and supported, while allowing members to drive their focus and direction. 
The Program Training and Consultation Centre’s Tobacco-Specific CoPs
The Program Training and Consultation Centre (PTCC), a resource centre for the Smoke-Free Ontario Strategy (SFO), institutes province-wide CoPs that bring together public health practitioners, researchers, NGOs and other partners to focus on tobacco control issues. Since 2008, six tobacco-specific CoPs have been hosted and supported by PTCC.
Recent CoPs include: Young Adult Tobacco Use Reduction CoP (YA); Tobacco-Free Sports and Recreation and Smoke-Free Outdoor Spaces CoP (TFSR); Smoke-Free Hospitals CoP; and a Workplace Learning Collaborative (WLC) that focused on workplace smoking cessation.
PTCC’s CoPs reflect two types of organizing models:
1) Member-driven model – CoPs comprised of members who join voluntarily and together negotiate the focus, direction, and end date of their CoP (e.g., the YA and TFSR CoPs).
2) Directed model – This model was implemented more recently by PTCC to support the implementation of government grant funded projects This model type is time-limited, operating for the duration of the grants. Participation in these CoPs is an expectation of grant recipients (e.g., the SFH and WLC CoPs).
PTCC hosts the CoPs and provides a health promotion specialist to coordinate all aspects of CoP functioning. In-person meetings, interactive webinars, and an online learning platform are implemented to encourage member interaction and knowledge exchange. Members themselves develop annual learning agendas for their CoP, assume rotating chairperson roles, and work with a health promotion specialist to plan meetings.
An evaluation was undertaken by Propel Centre for Population Health Impact (Propel) in 2014 to assess how the CoPs were meeting these goals.
Evaluating PTCC’s CoPs
Propel developed a survey to evaluate PTCC’s CoPs. Survey development built on previous evaluations of PTCC’s CoPs, the scientific literature, and feedback provided by PTCC staff and the CoP members serving chairperson roles. The survey was constructed as a monitoring tool to be administered on an annual basis. The survey tracks indicators that are important to CoP functioning and seeks to assess the influence that participation in PTCC’s CoPs has on members and their tobacco control practice. Specifically, the survey assesses: member characteristics; member participation in PTCC’s CoPs; the relevance of PTCC’s CoPs and the supports it offers to its members and their tobacco control practice; and the influence that participation in PTCC’s CoPs has on members and on tobacco control practice. Members were asked to reflect on the previous 12 months of their membership when answering survey questions.
In September 2014, 213 members across all four CoPs were invited to participate in a 15-minute online survey, with 113 of these members belonging to the member-driven CoPs and 100 members belonging to the directed CoPs. In total, 68/213 surveys were completed for a response rate of 32%. Overall, 31% (35/113) members from the member-driven model and 33% (33/100) from the directed CoP model participated in the survey.
Data across the four CoPs were combined and analyzed using descriptive statistics to examine potential differences between members’ responses based on type of CoP involvement. Overall findings across the four CoPs are presented below along with any patterns suggesting differences based on type of CoP model.
II Key Findings
Members are an essential component of a CoP because of the knowledge and perspectives they can contribute to the community. Across the CoPs, survey respondents represented a range of sectors, with most members coming from Ontario public health units, tobacco control area networks, and health care. Members were also commonly in program staff/direct service provider roles followed by managerial roles. Members spent the majority of their time (80–100%) working on tobacco control in their respective organizations. Membership duration ranged from one year or less to five years in the member-driven CoPs and up to two years in directed CoPs. Forty-two percent of respondents across the four CoPs had been CoP members for one year or less.
Most members (82%) felt that their CoP had the right people participating although there was interest in the member-driven CoPs to have more NGOs/community partners, government, researchers, and members from outside of Ontario participating. Members of the directed CoPs suggested the need for additional representation from public health units or organizations that had not received demonstration grant funding but also worked on similar initiatives.
Motivation to Participate
CoPs thrive when members are committed and motivated to contribute to the community in an ongoing manner. [8, 9] Factors that commonly motivated participation by members across the CoPs included the relevance of the CoPs to members’ work (83%) and the opportunity to learn from colleagues across the province (77%). When examined by CoP type, over 70% of those in member-driven CoPs as compared to just over half (~50%) of those in directed CoPs were also motivated by the opportunity to access resources/best practices and by their interest in the CoP topic area, respectively. Twenty-three percent of directed CoP members were motivated to participate compared to 3% from member-driven CoPs because they were required to attend.
How PTCC CoPs Support Members and their Tobacco Control Practice
Members also reported that their participation in the CoP helped to:
1. Improve networking and knowledge exchange
CoPs provide an important vehicle to support networking and the development of social capital, which in turn can make knowledge exchange easier.  Overall, 84%, (51/61) of CoP members reported both making new connections with members they did not know previously and strengthening pre-existing relationships with other members as valuable. Those from the directed CoPs reported this more often than those from member-driven CoPs. Ninety-four percent (59/62) of CoP members also reported becoming better aware of other members’/ organizations’ activities; 92% (57/62) reported exchanging information and knowledge with other members; and 62% (38/61) of members reported engaging in more collaborations where jointly planned and activity implementation took place.
2. Increase knowledge, skills and confidence
Through participation in CoPs, individuals gain technical knowledge and new skills that help them do their work better.  In PTCC’s CoPs, 90% (57/63) of participants reported that they had gained new knowledge (79% or 50/63); skills (85% or 54/62); and confidence (82% or 50/61) to apply what they had learned from participation in the CoP. In the member-driven CoPs, there was some indication that members experienced more improvements than those from directed CoPs with respect to skill development (85%, member-driven vs. 72% directed CoPs) and in particular confidence (91%, member-driven vs. 71% directed CoPs). Most members 85% (54/62) across the CoPs also commonly identified being better able to identify and address emerging tobacco control issues as a result of their participation in the CoPs.
3. Engage in Evidence-Informed Practice
The utilization of evidence to inform practice is a key objective of the CoPs. As a result of CoP participation, members across the four CoPs commonly reported engaging in evidence-informed practices. Overall, 72% (44/61) of members reported that their CoP participation better equipped them to develop, implement and evaluate evidence-informed initiatives (i.e., policies and programs) (71%, n=44/62), with more members of the directed CoPs reporting an improved ability to evaluate initiatives than those from member-driven CoPs. This latter finding may be because funded demonstration projects included a centrally coordinated evaluation component that was explicitly discussed in the community.
Overall, 89% (56/63) of members also reported using evidence and resources accessed through the CoP on a regular basis (i.e., some of the time to all of the time) to inform work-related decisions and actions, with comparable results across CoP types.
Benefits of CoP Participation
Several benefits were also commonly experienced by CoP members as a result of their participation, including:
- Interacting with colleagues across the province that would otherwise not occur regularly (97%, 57/59)
- Improved access to other organizations’ practices and resources helping to reduce duplication of efforts (98%, 58/59)
- Creation of new ideas and solutions relevant to the CoP practice area (98%, 58/59)
- Improved capacity beyond that of members’ organizations alone to address the CoP topic area (88%, 51/58), with member-driven CoP members indicating this more often (97%, 30/31) than directed CoP members (78%, 21/27).
- A stronger sense of belonging to Ontario’s tobacco control community (88%, 51/58).
III Discussion and Concluding Statement
The survey findings suggest that PTCC’s CoPs support knowledge and skill development; knowledge exchange and learning across individuals and organizations; and evidence-informed tobacco control practice. Findings also suggest that both CoP types (member-driven and directed) benefit members in similar ways. While more research is needed, investments in both types of CoP models appear to be worthwhile either to support tobacco control practices that are both an ongoing part of practitioner job responsibilities and organizational mandates, or are time-limited and tied to specific grants.
Overall, PTCC’s CoPs offer an important learning mechanism in the Ontario tobacco control system with members reporting benefits that can accelerate improvements in their tobacco control work. Practitioners working in tobacco control or other chronic disease prevention areas may benefit from joining existing CoPs or creating their own, and PTCC’s CoPs may provide a useful model to inform their development.
For more information about PTCC’s CoPs please visit https://www.ptcc-cfc.on.ca/learn/CoPs/.
For more information on the evaluation reported in this bulletin, please contact: [email protected]
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