Welcome to IDM Best Practices
for health promotion, public health and population health

using the IDM Best Practices Framework

The IDM Best Practices Framework, the practical application of the IDM, is a multi-purpose "change" tool for practitioners and organizations in any situation who want to pursue a best practices approach to health promotion. Using a health promotion filter to ensure that practice is consistent with health promotion underpinnings and understanding of the environment, the IDM Framework can help to:

• increase understanding of health promotion, and build capacities and supports
• make decisions and policies
• increase communication and "team build"
• plan, implement, evaluate, and revise programs/activities that are sensitive to local conditions
• "make the case" for programs/activities
• achieve health promotion goals

commitment to ongoing questioning and reflection

The application of the IDM to practice involves ongoing questioning and reflection:

• What are our health promotion underpinnings and understanding of the environment?
• How well does our practice match our underpinnings and understanding of the environment?
• How can we increase the consistency between practice, underpinnings and understanding of the environment?
• How do our processes, activities and outcomes relate to each other, and how can we improve them?
• What resources, capacities and supports do we have to draw on, and how can we maintain and enhance them?

health promotion filter

Down the side of the Framework are the domains and subdomains from the IDM, that is, underpinnings (values, goals and ethics, theories and beliefs, evidence), understanding of the environment (vision and analysis), and practice (responding to issues, and research and evaluation). These act as a health promotion filter for the Framework's steps.

Framework steps

Evidence Framework steps

The IDM Evidence Framework for best practices is the "offspring" of the general IDM Best Practices Framework and is to be used in conjunction with it. Its steps are:

1. Ask the health promotion question.
2. Conduct research (including evaluation) to answer the question by:
   • identifying and selecting information
   • analyzing the information gathered, summarizing or synthesizing the findings, and reporting the findings
   • filtering the information to ensure that it is: relevant to our question, consistent with and reflective of health promotion underpinnings and understanding of the environment, high quality, and applicable to our situation.
3. In conjunction with underpinnings and understanding of the environment, use the resulting evidence to make practice decisions.
4. Implement these decisions.
5. Evaluate on an ongoing basis our decisions and our practice.
6. Revise where necessary our decisions and our practice processes and activities.
7. Enter a new cycle of planning, implementation and evaluation.

requirements for using the IDM Best Practices Framework

To effectively use the IDM Framework requires:

• a cooperative effort by the group, organization and/or community to determine areas of agreement and disagreement concerning each subdomain (that is, values, theories, evidence, analysis of the environment, etc.)
• a process to address differences so we can
  (a) constructively use the creative tension sometimes produced by differences and
  (b) minimize possible negative effects
• an explicit definition for each major term or concept used (for example, for health, health promotion, equity, empowerment) so we speak a common language
• processes for follow up to the results of ongoing reflection and evaluation to ensure continuous improvement

what the IDM Best Practices Framework looks like

IDM Best Practices terminology

The alphabetical list that follows defines key terms as they are used in the IDM approach to best practices in health promotion.

action and evaluation plan

• details on how to achieve a set of specific objectives, including who does which activities/tasks/processes, when, and taking into account resources and challenges

analysis

• identification of the factors involved in a given issue, and their respective roles and relationships, with respect to the issue, for the purposes of clarification and understanding

best practices in health promotion

• "those sets of processes and activities that are consistent with health promotion values, goals and ethics, theories and beliefs, evidence, and understanding of the environment, and that are most likely to achieve health promotion goals in a given situation." (Kahan and Goodstadt, 2001)

capacities

• the potential to acquire, develop and apply understanding and skills

challenges

• circumstances that have the potential to hinder the achievement of a specific objective; these can range from the tangible (e.g., inadequate funding, low quality equipment, inappropriate physical space) to the intangible (e.g., inadequate skills, inappropriate understanding, low commitment levels), and can exist at any level (e.g. organizational, regional, national, international)

current

• what is happening now

determinants of health

• "those factors which contribute to the health of populations or individuals in those populations" (Health Canada, 1997)
• the determinants of health work synergistically and operate on individual, community and societal levels; they include income (i.e. individual income and the degree of income equity in a society), status, education, power/control, social cohesion/support, nature of social, political and economic environments, and individual health-related behaviour and resilience

document

• make note or keep track of

domain

• a cluster of factors relating to underpinnings, understanding of the environment, or practice, each of which significantly affects best practices in health promotion (see also subdomain)

effectiveness

• the achievement of health promotion goals
• the pre-requisite for effectiveness is: practice that is consistent with health promotion values/goals, theories/beliefs, evidence, and understanding of the environment

environment

• the circumstances, objects, or conditions that surround us, including: people; social, political, and economic systems and structures; psychological and physical conditions
• environments exist at a number of levels/layers, including, for example, our immediate work teams, our organizational context, and provincial, national, and international influences (see also health-related environment and organization/work-related environment)

ethical principles

• guidelines for appropriate values-based conduct

evaluation

• a set of research questions and methods geared to reviewing processes, activities and strategies for the purpose of improving them in order to achieve better results (see also research)

evidence

• information that is used in making decisions (from Butcher 1999)

goals

• what we strive to achieve; the concrete manifestation of values

health

• "the extent to which an individual or group is able, on the one hand, to realize aspirations and to satisfy needs and, on the other hand, to change or cope with the environment" (WHO European Region, 1984)

health environment

• the structures, systems and conditions at a number of levels (e.g., organizational, community, regional, national, and international) that affect our health directly or indirectly

health-related issues

• situations or conditions related to health which require action; factors which contribute to or detract from health, requiring either maintenance/enhancement or reduction/prevention

health promotion

• "the process of enabling people and communities to increase control over factors that influence their health, and thereby to improve their health" (adapted from Ottawa Charter Of Health Promotion, 1986)

health promotion criteria and guiding principles

• standards or recommended ways for taking action from a health promotion perspective; can be used to assess or guide action

healthy public policy

• "Healthy public policy is characterized by an explicit concern for health and equity in all areas of policy and by an accountability for health impact" (WHO, Adelaide Conference on Healthy Public Policy, 1988)

ideal

• standard of excellence; the ultimate aim or object for which we are striving

implementation

• carrying out identified actions/tasks/processes

indicator

• something that tells us (that is, indicates) whether we have achieved an objective or answered a question

objectives

• what we need to accomplish in order to achieve a more general goal; objectives are generally designed to be observable or measurable

organization/work environment

• the structures, systems and conditions at all levels (e.g., group/organizational, community, regional, national, and international) that directly or indirectly affect our work and/or our work-related group or organization

organization/work-related issues

• situations or conditions related to the organization and/or work which require action; factors that facilitate or interfere with the effectiveness of practice, requiring either maintenance/enhancement or reduction/prevention

outcomes

• intended or unintended results (short- or long-term) of activities/strategies/processes

picture of ideal situation

• concrete details of what our situation would look like if it were consistent with our health promotion criteria and guiding principles

practice

• one of the domains of the Interactive Domain Model; its subdomains include our response to health-related issues, organization/work-related issues, and research/evaluation
• includes both activities and processes involved in conducting our work; sets of practice activities/processes make up "strategies"

research

• sets of activities designed to answer selected questions (see also evaluation)

resources

• include tangibles such as funding, equipment, and physical space, and people, and intangibles such as time, skills, understanding, and attitudes

response

• activities, strategies, and related processes used in practice to address an issue

revise

• make changes

subdomain

• one of several factors clustering together with other factors to form a domain
• subdomains included in the domain of underpinnings: values/goals/ethics, theories/concepts/beliefs, evidence
• subdomains included in the domain of understanding of the environment: vision, and analysis, of (a) health-related issues, and (b) organization/work-related issues
• subdomains included in the domain of practice: responses to (a) health-related issues, and (b) organization/work related issues, and research and evaluation

theories/concepts

• theories/concepts explain how and why things happen, and predict what might happen (these can be simple or complex, formal or informal)

underlying beliefs and assumptions

• determine our approach to life and guide us in our decision choices; they do not necessarily refer to external/objective evidence

underpinnings

• one of the domains of the Interactive Domain Model; its subdomains include values/goals/ethics, theories/concepts/underlying beliefs, and evidence

understanding of the environment

• one of the domains of the Interactive Domain Model; its subdomains include vision, and analysis, of health-related issues, and of organization/work-related issues

values

• what is most important to us

vision

• a picture or image of how we would like things to be

IDM Best Practices FAQs

Framework's table format

With all those boxes in a table format, isn't the Framework too rigid for health promotion work, which is all about people and not about straight lines?

• The Framework is shown in a table format because it provides a clear picture of its component parts, and because many people find tables help organize thoughts and material. However, we don't have to use the Framework in a table - instead, we can use the headings and follow a paragraph or point style.
  
  In addition, because the Framework forces people to think critically about what they are doing and why, and what they could be doing instead, with the right approach the Framework can be a creative tool rather than rigid. One of the participants during the initial pilot testing period of the Framework stated that one of the things she liked best about the Framework was that it forced her to think outside the box. Other participants stated that as a result of working through the Framework, discussions evolved that were not the norm.

necessity for doing whole Framework

Do we have to do the whole Framework?

• The Framework is just a tool, and if we can practise health promotion in a way that is consistent and reflective of our underpinnings and understanding of the environment without the Framework, that is fine. The Framework is there to help us if we need it. It is also there to help us in the best ways in whatever way we need it.
  
  It is true that the Framework as a whole can seem daunting. However, the Framework allows us to break into small chunks the task of reflecting on our underpinnings, understanding of the environment and practice. We can't do it all at once even if we wanted to, there is too much - the Framework presents a process for picking a piece at a time, while maintaining a record of all the other pieces when we are ready to look at them.

meaning of underlying premise

What does the underlying premise of the Model actually mean, that the quality and value of practice depend on the degrees of awareness, articulation, clarity, and reflection associated with each of its categories?

• Taking violence against women as an example might help explain. If we're not aware that violence against women is an issue we won't do anything about it; if we don't talk openly about it we can't do anything about it; if we are unclear who it affects and what factors influence it and what the possibilities are for dealing with it we likely won't address it very effectively; and if we don't reflect on what we think and understand and are doing about it we likely won't improve in our efforts to address it.

fit with evidence-based approach

How does the IDM fit with an evidence-based approach?

• The IDM is an evidence-based approach which considers evidence a major factor in decision making. But it is more than an evidence-based approach because it considers a number of other factors to be important as well, including values and theories and understanding of the environment, and emphasizes how all these factors interact with each other. In other words, the IDM is also a values/ethics-based approach and a theory-based approach. To focus only on evidence would leader to a narrow rather than an in-depth understanding of health promotion issues, environments and practice.

who can use Framework

Who can use the Framework?

• The Framework is meant for anyone working in the field of health promotion, public health or population health who wants to critically reflect on their practice. It might also be used by those working in other fields, if there is an overlap in the areas of concern. It is a generic tool which provides the framework but allows each group to provide the content. It can be used with any range of issues, stages of an initiative, levels of health promotion understanding, organizations, organizational levels, organization roles, or professional or practice backgrounds

duplicating other tools

Why do we need the IDM Framework - aren't there other planning tools out there already that we can use?

• Other planning tools have some of the features of the IDM Framework, but none have all of them. The IDM Framework combines features from other health promotion frameworks in a unique way to make it:

  • solidly grounded in health promotion -- taking fully into account health promotion values, goals and ethics, theories and beliefs, evidence, understanding of the environment, and practice (including both processes and activities)
  • comprehensive - attending to all the major factors that influence practice
  • systematic - ensuring that nothing "gets lost in the shuffle"
  • reflective - thoroughly considering the pieces that often are left unexamined (i.e. the underpinnings of practice and understanding of the environment and their fit with practice), as well as ongoing review and revision of practice itself
  • generic - with wide applicability to a variety of circumstances
  • flexible - being wholly sensitive and responsive to the specific conditions of each situation
  • focused on both outcome and process issues -- and the relationships between them
  • focused on both building capacities and constructively addressing challenges
  • optimize potential benefits and minimize potential risks

  In addition, it unexpectedly turns out that the IDM is more than a planning and evaluation tool. Sites have found it helpful in a number of other ways as well, for example as a communication tool and a team-building tool.

necessary for results

How do you know we wouldn't come up with the same results without using the IDM Framework?

• When asked this as part of a panel at the 2001 Best Practices Annual Stakeholders Meeting, one of the original pilot sites responded that as a result of working through the Framework they used a higher level of analysis than they would have otherwise, spent more time on planning, and put more stress on the work environment, which was helpful to them in terms of managing and controlling it.
  
  We may not know for sure until there has been more in-depth testing, but pilot testing indications are that using the Framework did make a positive difference.

time constraints

We have too much to do already - why would we want to spend time on the Framework?

• The best reason is that it will help us achieve our health promotion goals. It is a way to make sure we don't overlook important factors, that we continuously reflect and improve, and that we take a holistic rather than a narrow approach to our work - in other words, that we put into practice our values and beliefs, and consider the evidence. In addition, there is a good chance that the time we spend on it now will save us time in the long run. And, some people really enjoy working on the Framework and find it energizes them!

finding the time

Even if we want to use the Framework, where will we find the time in our overwhelmingly busy workdays?

• One: Wherever possible, use the Framework to complement or replace rather than as an extra. In this way, it adds value to what we are already doing. For example, most of us already spend time planning. In that sense, using the Framework for planning is time we already have to spend.
  
  Two: Recognize that to benefit from its full potential, we may need to put a fair amount of time into the Framework in the beginning - but as one site pointed out, it is a case of short term pain for long term gain. Initially, it may take a while discussing and putting our thoughts down and organizing and refining them - but once done, it is simply a matter of reviewing on a regular basis, which goes more quickly. Also, if we wanted to do the Framework process with another project, a lot of the thinking will be transferable. And, if doing the Framework process improves our effectiveness, we will save time down the road as well as have a greater positive impact on our particular issue.
  
  Three: Understand that the Framework can be done superficially or it can be done in-depth. In fact, it is probably best to do a quick run-through in the beginning rather than getting bogged down in details and trying to be comprehensive all at once. As time goes on we can refine and add details, especially if we schedule regular times to work on it. Scheduling blocks of time in advance "protects" that time. There is no reason why the Framework can't be done in planned stages.

complexity

The IDM looks really complex and overwhelming - is it possible for most of us to get a real grip on it and use the IDM Framework effectively?

• While it may appear daunting, using an adult education approach in workshops has shown that people do have an intuitive understanding of the IDM as a result of their own practice experiences. The application piece is more challenging. But it is like any new skill, whether learning to walk, read, use a computer, nurse, teach - at first it is hard because we have to use muscles or parts of our brain we maybe didn't know we had - but as we persevere we become more familiar and at a certain point it becomes second nature. According to some of the original pilot site members, eventually you internalize the process. One of the benefits of working in a group is the combination of strengths to draw on. Through group discussions it will likely become clearer as group members share their insights.

use with community

How can we use the IDM when working with community - aren't the language and the concepts too complicated?

• The complexity of the IDM is one of those double edged swords, a strength and a challenge. The strength is that it reflects the complexity of life where numerous factors and influences interact with each other all the time in all sorts of combinations; the IDM may be many things but it is not a reductionist approach. As one site member stated, the IDM is like an eco-system, and no matter where you start, you end up with all of it, because everything relates to everything else.
  
  The challenge is that the complexity sometimes makes it hard to know where to start, what to do with it all, and how to present it. When working with anyone, community members included, presentation is often the key part. We don't have to start out with models and tables, which many people dislike. And we can make an effort to use plain language. People are social beings and generally like to talk and discuss things. There are simple "IDM questions" that can get the ball rolling and result in a wealth of information which can be used to continue the Framework process. Examples include: What are we doing and why are we doing it? What do we value most? If we could have any wish granted, how would we like things to be? What things in our lives - people, organizations, skills - do we find most helpful? What solutions have we discovered to problems we have had that we could share with others?
  
  In addition, as a tool which assists us to identify all the major pieces relating to our issues and work and how they work together, use of the IDM Framework deepens our understanding of the complexity which surrounds us, helping us to grapple more effectively with it - as long as we approach the Framework in bite size pieces rather than attempting to swallow it all at once.

working with differences

Everyone is at such different levels regarding experience and understanding, how is it possible to work together on the Framework?

• Again according to original pilot site members, the Framework helps people work towards a common understanding of terminology and work. On the same panel mentioned before, some members stated that it helped people with different backgrounds and levels to work/learn together as a group, brought cohesiveness and shared understanding to the group, and provided an opportunity for interdisciplinary and community movement towards shared values.

suitability for diversity

Taking account of diversity is so central to health promotion work; in what ways does the IDM reflect diversity, or is it suitable only for mainstream groups?

• The IDM and its Framework, through their flexibility, accommodate and reflect diversity extremely well, and are therefore suitable for all groups who want to use them. While the IDM and its Framework outline categories of major domains and subdomains for groups to consider, they do not dictate the contents. For example, while the IDM and Framework stress the importance of each group identifying and defining their health promotion values and including them in practice, they do not specify what these particular values are. And rather than insisting everyone should agree with each other on every point, the Framework recommends identifying the range of agreement and differences among key stakeholders and working with that in whatever way stakeholders think best. Particular care was taken in the design of the Framework to make it adaptable to a variety of groups and situations, as practitioners who participated in the initial best practices scan made it very clear they did not want a cookie cutter or "one size fits all" approach.
  
  Even the table format of the Framework is not a necessity, but can be modified to whatever format works best for any particular group; working through the Framework does not have to be done in any set way, but is flexible enough to allow a wide variety of approaches.
  
  While a suggested set of criteria and guiding principles are provided, these were developed primarily in response to practitioners' requests for concrete examples; they can be accepted, rejected or revised depending on the perspective of any particular group. In fact, any group using the IDM Framework is encouraged to develop their own health promotion criteria and guiding principles; this will result in criteria and guiding principles which are more meaningful and applicable to the particular situation, and truly reflective of diversity.

necessity for guiding principles and criteria

Why do we need to bother with the first column of the Framework, that is, developing a set of general health promotion criteria and guiding principles?

• Having a set of general health promotion criteria and guiding principles serves a number of purposes. We can use it as:

  • a checklist to identify all important elements in our current situation
  • a "measure" to help us assess our current strengths (resources, capacities, what works well) and challenges (concerns, barriers, gaps)
  • a wide-ranging palette of colours for us to choose from when we start to paint a picture of the ideal that is appropriate for our specific situation
  • our own broad-based definition and understanding of health promotion which is usable with any program or initiative we are working on