The diversity of prevention and health promotion services offered by Québec Community Health Centres: a study of infant and toddler programmes.

Research has shown that preventive and health promotion (PHP) services offered by community health centres are often vulnerable in times of health reform or budgetary cutbacks. The present study was conducted in Québec, Canada, approximately 10 years after the start of a major transformation of health care services. The objectives were: (1) to examine the diversity of infant/toddler prevention and health promotion services offered by centres locaux de services communautaires (CLSCs, local community health and social services centres); and (2) to investigate the organisational and environmental correlates of such diversity. All Québec CLSCs were invited to complete a survey questionnaire regarding their PHP services (response rate = 69%). Data on environmental and organisational factors were extracted from existing Québec government data sets. Bivariate and multivariate analyses were performed to identify the correlates of the CLSCs' level of diversity of PHP services. The results revealed that CLSCs varied greatly in terms of their diversity of PHP services. The number of full-time equivalents in the Child and Family Services Programme (one of two programmes aimed at reaching the targeted clientele) and the degree of CLSC collaboration with other community-based organisations in the planning and delivery of PHP activities were positively associated with the level of diversity, whereas the unemployment rate in the population served was a negative predictor. This study makes an important contribution in being one of the very few which contribute to building our knowledge about the performance of community health centres. Identifying the correlates of diversity among PHP services offered by CLSCs helps us to begin to understand the processes at work in the production of PHP activities, as well as the potential leveraging forces.