In Canada, many families want to breastfeed, but there are several common challenges they may encounter. Currently, 91% of Canadian families initiate breastfeeding after giving birth, yet only 38% of babies are breastfed exclusively to 6 months. In 1991, the Breastfeeding Committee for Canada (BCC) was established to implement the World Health Organization’s Ten-Step Baby-Friendly Hospital Initiative, a series of evidence-based in-hospital practices to support families to breastfeed. Then, in recognition of the need to support breastfeeding beyond the hospital setting, the BCC expanded the Baby-Friendly Initiative (BFI) to apply the Ten Steps to both hospitals and community health settings. However, uptake of the BFI Ten Steps in community settings has been low and methodology on how to optimise implementation of the Ten Steps in community is not well developed. Therefore, the objective of this project is to develop and evaluate a quality improvement collaborative with 25 community health services from across Canada to learn how to best support the implementation of the BFI Ten Steps in community, with the ultimate goal of improving breastfeeding outcomes.

This protocol describes the activities of the Community Baby-Friendly Initiative Collaborative (CBFI-C) and the methods used to evaluate its effectiveness. We will use the Institute for Healthcare Information Breakthrough Series (IHI-BTS) model, a proven quality improvement model that has been widely used in clinical settings, but is not yet widely used in community settings. The IHI-BTS combines three virtual learning sessions with action cycles that allow the participating sites time to test and track small practice changes. Sites will be asked to track care indicator and breastfeeding outcome data, engage in monthly webinars, receive coaching from trained mentors, participate in focus groups and participate in a final summative workshop. We will use a multi-site case study approach, combining aggregate care indicator data and qualitative data from webinars, focus groups and workshops to evaluate how the CBFI-C model supports community sites in the process of implementing the BFI Ten Steps.

Ethics approval for this evaluation was obtained from the CHIPER Health Research Ethics Board (Number HS26947-H2025:157)). The results of the CBFI-C evaluation will be shared in a report, peer-reviewed publications and presentations to government and academic audiences. The findings will inform effective quality improvement strategies to enhance uptake of the BFI in community health settings.

Brain and heart conditions are among the leading causes of illness and mortality in Canada. Heart failure is one of the fastest-growing cardiovascular conditions globally, with more than 100 000 Canadians diagnosed each year. Individuals with heart failure are at significantly increased risk of mental health challenges such as depression, anxiety and stress. However, healthcare services often remain siloed, treating physical and mental health separately. This complicates care for individuals with multiple chronic conditions. This multiyear study will adapt, test and accelerate changes to regional care delivery models in Eastern Ontario to optimise brain-heart health and generate knowledge to support the spread and scale of effective interventions that address community needs and priorities. We aim to: (1) identify resource gaps by mapping available services; (2) document strengths and challenges in care delivery; and (3) co-design, pilot test and evaluate an intervention developed based on the priority gap area(s) identified through objectives (1) and (2).

This community-based participatory action research study is led by a research coalition of patient and caregiver partners, care providers and leadership staff from two Ontario Health Teams. In Year 1, we will conduct asset mapping and community consultations with individuals living with heart failure, caregivers, care providers and service organisations to identify care gaps, strengths and opportunities for improvement around modifiable behavioural risk factors and brain-heart health. A scoping review will identify evidence-based strategies to address care gaps and inform the co-design of an intervention focused on supporting individuals with brain-heart interconnected conditions. In Year 2, we will co-design an intervention with community partners for implementation with clinical test sites. Year 3 will involve pilot testing the intervention and conducting outcome and process evaluations. This will inform future spread and scale of the intervention to other brain-heart conditions and new jurisdictions.

The study is approved by the Bruyère Health Research Ethics Board (M16-24-016). Findings will be disseminated through peer-reviewed publications, conference presentations and knowledge mobilisation activities such as social media, community events and local media outreach, as well as through dedicated engagement with Ontario Health partners and the Brain-Heart Interconnectome Network via retreats and collaborative forums.

Compassionate care transcends the mere clinical treatment of illness to encompass the psychological and social dimensions of patient well-being. It is often unclear how physicians from different specialities perceive this complex process. This study aimed at identifying their different views on compassionate care in daily clinical practice.

A Q-methodology study was conducted. This mixed-method methodology combines quantitative and qualitative analysis to identify participants’ subjective viewpoints. Participants ranked 53 statements on the dimensions of compassionate care according to their point of view, followed by an interview. Principal component analysis, followed by varimax and additional manual rotation, was used to identify groups that shared similar views.

Two hospitals, one facility for people with disabilities and three private practices in Belgium.

29 physicians from different specialties with clinical practice were purposively sampled.

Three views on compassionate care in daily practice were identified. The task-oriented view attached the most importance to making the best use of clinical knowledge and expertise and acting in the best interest of the patient, accompanied by clear and appropriate communication of medical information. The system-oriented view emphasised an authentic and non-judgemental attitude, as well as a relationship of trust, self-reflection, clinician’s well-being and a compassionate working environment. Lastly, in the relationship-oriented view, the focus was on building a relationship of respect and trust with the patient by active listening and getting to know the patient, and engaging him in the care process. The physicians’ viewpoints varied by specialty and setting.

The findings of our study and the approach taken contribute to further clarifying the differences in physicians’ views on compassionate care in daily clinical practice. Physicians loading on the task-oriented view worked mostly in highly technical or acute care environments. In the system-oriented view, they were active in paediatrics and primary, palliative and mental healthcare. And in the relationship-oriented view, physicians often worked with oncology patients or patients with chronic diseases. These findings may have an impact on a better understanding of compassionate care in different clinical settings, facilitate the design of compassion training and ultimately improve patient care and satisfaction.