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Research
Assessment of the implementation fidelity of the Arctic Char Distribution Project in Nunavik, Quebec
  1. Lara Gautier1,2,3,
  2. Catherine M Pirkle4,
  3. Christopher Furgal5,
  4. Michel Lucas6,7
  1. 1Department of Social and Preventive Medicine, Université de Montréal, Montreal, Québec, Canada
  2. 2Public Health Research Institute, Université de Montréal, Montreal, Québec, Canada
  3. 3Centre d'Etudes en Sciences Sociales sur les Mondes Africains, Américains et Asiatiques, Université Paris Diderot-Paris 7, Paris, France
  4. 4Office of Public Health Studies, University of Hawaii-Mãnoa, Honolulu, Hawaii, USA
  5. 5Indigenous Environmental Studies Program, Trent University, Peterborough, Ontario, Canada
  6. 6Department of Social and Preventive Medicine, Université Laval, Québec, Québec, Canada
  7. 7Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre, Québec, Québec, Canada
  1. Correspondence to Lara Gautier; lara.gautier{at}umontreal.ca

Abstract

Background 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.

Methods 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 et al in 2007.

Results 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.

Discussion 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.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

http://dx.doi.org/10.1136/bmjgh-2016-000093

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    Footnotes

    • Handling editor Valery Ridde

    • Twitter Follow Lara Gautier at @Lara_Gautier

    • Contributors LG conducted the second set of interviews, carried out thematic coding of all interviews and project documentation, and drafted the initial version of the manuscript. CMP co-conceived the study, participated in its original design and coordination, conducted field observations, carried out the coding, and provided substantial inputs to the manuscript. CF revised each version of the manuscript and provided substantial inputs to the manuscript. ML co-conceived the study, participated in its design and coordination, provided substantial inputs to the manuscript, and ensured the study supervision. ML had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final manuscript.

    • Funding The study was supported by grants from Canadian Institutes of Health Research (CIHR) Operating Grant: Population Health Intervention Research (#127069) and the Nunavik Regional Board of Health and Social Services (NRBHSS). The funding sources were not involved in the data collection, data analysis, manuscript writing and publication.

    • Competing interests Lara Gautier’s current PhD thesis is supervised by Valéry Ridde who acted as Handling editor for this paper. The Handling editor was not involved in any part of the evaluation or peer-review process of this article.

    • Ethics approval Ethics committee of CHU de Québec Research Centre.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.