Gautier Lara, Pirkle Catherine M, Furgal Christopher, Lucas Michel
Department of Social and Preventive Medicine, Université de Montréal, Montreal, Québec, Canada.
Public Health Research Institute, Université de Montréal, Montreal, Québec, Canada.
BMJ Glob Health. 2016 Oct 24;1(3):e000093. doi: 10.1136/bmjgh-2016-000093. eCollection 2016.
In September 2011, the Nunavik Regional Board of Health and Social Services began supporting the Arctic Char Distribution Project (AC/DP) for pregnant women. This initiative promoted consumption of the fish Arctic char-a traditional Inuit food-by pregnant women living in villages of Nunavik, an area in northern Quebec (Canada) inhabited predominantly by people of Inuit ethnicity. This intervention was intended to reduce exposure to contaminants and improve food security in Inuit communities.
We assessed the project's implementation based on data collected from background documentation, field notes and qualitative interviews with project recipients and implementers. Themes emerging from the data are critically discussed in the light of the framework for implementation fidelity developed by Carroll in 2007.
Pregnant women fully embraced the initiative because of its cultural appropriateness. However, project implementation was incomplete: first because it did not cover all intended geographic areas, and second because of a recurring inconsistency in the supply and distribution of the fish. In addition, the initiative has been inconsistently funded and relies on multiple funding sources.
This work highlights the extent to which project complexity can impede successful implementation, particularly in terms of communication and coordination. We provide recommendations for improving project implementation and suggest amendments to the implementation fidelity framework.
2011年9月，努纳维克地区卫生和社会服务委员会开始支持一项面向孕妇的北极红点鲑分发项目（AC/DP）。该倡议旨在促进居住在努纳维克村庄的孕妇食用北极红点鲑这种传统的因纽特食物，努纳维克是加拿大魁北克省北部的一个地区，主要居住着因纽特族裔的人。这项干预措施旨在减少因纽特社区接触污染物的情况并改善食品安全。
我们根据从背景文件、实地记录以及对项目接受者和实施者的定性访谈中收集的数据，评估了该项目的实施情况。根据卡罗尔在2007年制定的实施保真度框架，对数据中出现的主题进行了批判性讨论。
孕妇们因该倡议符合文化传统而欣然接受。然而，项目实施并不完整：一是因为它没有覆盖所有预定的地理区域，二是因为鱼类供应和分发中反复出现不一致的情况。此外，该倡议的资金来源不稳定，依赖多个资金渠道。
这项工作凸显了项目复杂性在多大程度上会阻碍成功实施，尤其是在沟通和协调方面。我们提出了改进项目实施的建议，并对实施保真度框架提出了修订意见。
