Synergie

Why do this study?

Low-cost housing tenants are among the most vulnerable populations in North America. Their health status is poorer than that of people in the lowest income quintiles and their life expectancy is shorter. These social inequalities in health are socially produced, through unequal distribution of power and resources, and are therefore modifiable. Reducing social inequalities in health is a priority for two reasons. Ethically, such inequalities are unjust and not respectful of social rights. Economically, they are unacceptable given the importance of our collective wealth, the significant healthcare costs involved, and the fact that they deprive society of the constructive contribution of a significant portion of the population.

Two conditions are essential for the development of effective actions to reduce social inequalities in health: 1) intersectorality (in order to modify the social determinants of health); and 2) the participation of the target population in the development, implementation, and evaluation of actions. The Synergie project will allow HLM tenants to co-develop and co-pilot, with senior leaders from four sectors (health, housing, municipality, community), actions to improve the well-being of their community. The approach will have a beneficial effect on two crucial factors in reducing social inequalities in health: the control that a person can exercise over his or her life and his or her social capital. Tenants will be the ones making the final decisions about innovative actions in their communities, thereby exercising control over their environment, and they will have the opportunity to build relationships with neighbors and decision-makers, thereby increasing their social capital.

Objectives

The Synergie Project is a community-based participatory research project that aims to:

• Describe the process of co-development and co-piloting of intersectoral actions to promote well-being, including the evolution of relationships between tenants, decision-makers and researchers (power sharing, development of trust, resolution of disagreements);
• Evaluate the acceptability and feasibility of the pilot actions in the HLM environment;
• Examine the potential for generalizing the co-development and co-piloting method to other contexts.

Methodology

The project will take place at Habitations La Pépinière located in the Mercier West district of Montreal. This HLM complex is occupied by 176 households, including 321 adults and 198 children. The project will be led by a governance committee composed of two researchers, two partners, and two to four tenants. It will be carried out in five successive phases:

1. Site Familiarization and Tenant Researcher Recruitment (Summer and Fall 2018) A research assistant will visit the site several times and speak with representatives of organizations already working on the site to get an initial description of the most salient issues and contextual factors. She will also make herself known to tenants who may be potentially interested in participating in the project.
2. Tenant Researcher Preparation (January – March 2019) Weekly meetings will be held with the tenant researcher team to get them to work effectively together and prioritize the challenges they would like to work on in the project.
3. Co-development of wellness promotion actions (Winter and Spring 2019) Five meetings will be held between tenants and senior management between April and June 2019 at a rate of one meeting every three weeks. These meetings will make it possible to design, together, the actions that can be implemented to solve the difficulties identified by the tenants.
4. Action co-leadership and pilot study (Summer and Fall 2019) Actions will be implemented over six months. A co-piloting committee of tenants and senior management delegates will meet monthly to review progress, resolve issues, and suggest adaptations. The acceptability and feasibility of the actions will be evaluated.
5. Assessment of the experiment and potential for generalization (Winter 2020) Preliminary results will be shared with the entire co-development committee, which will participate in interpreting them and identifying future implications. Individual interviews with tenants and senior managers will document the impact of the experiment.

Despite the risks involved, the Synergie project will make a significant and unprecedented contribution to population health intervention research, an emerging field of research, and will generate important spin-offs:

1. In-depth and critical description of the innovative co-development process: By documenting the successes and failures of our unique intersectoral power-sharing approach to health promotion development, we will be able to reinvent existing practices. If successful, our co-development approach will be transferable to diverse populations, such as people experiencing homelessness and First Nations people.
2. Pilot data needed for a larger research program: Our team will build on the lessons learned from this initial experience by subsequently conducting a multiple case study to document the generalization and adaptation of the method to different contexts. Based on the results of the multiple case study, we will determine the content of a new mental health promotion program in low-income housing settings, the effectiveness of which will be evaluated by a randomized controlled trial.
3. Development of a living force inside the HLM: The tenants involved in the process of co-development of actions will have developed their capacities, exercised their power, and increased their social capital. Those are essential ingredients for the reduction of social inequalities in health. At the end of the project, they will be able to use these new skills and relationships to produce further improvements to their living environment.
4. Reduced stigma and improved partnership relations: By reducing institutional distance and giving tenants the opportunity to share their experiential knowledge, the Synergie project will help reduce stigma (and self-stigma) towards disadvantaged people. In addition, the CIUSSS, the Office municipal d’habitation, the city hall and the Table de quartier will have forged closer partnerships that can generate innovations beyond the scope of the project.

Site Familiarization – During the summer of 2018, a facilitator, a member of the research team, was present in the field and participated in activities organized by Project Harmonie (e.g., collective cooking, walking activity, outing to the botanical garden, etc.) in order to become familiar with the site and build relationships with tenants. She then organized thematic coffee meetings to speak with the tenants about their perceptions of the strengths and needs for improvement of their residential environment. At that time, approximately four to six tenants attended the meetings. This period spanned almost a year and highlighted the importance of developing trusting relationships with tenants before starting the project.

Tenant and Senior Leadership Relationship Development – In March 2019, we held the first formal tenant readiness meeting, which we called a “citizen café.” We wanted to reach a variety of households and recruit a dozen tenants. In order to achieve this, we created the best possible conditions to ensure the participation of as many tenants as possible, based on the suggestions of the participants already mobilized by the project. In this sense, the meetings were held at supper time, during the week. We also offered a meal and provided childcare. Finally, during these bi-monthly meetings, about thirty tenants met each time to discuss the strengths of their environment as well as the problems that affect their health and well-being. They also prioritized the actions they wanted to discuss with senior leadership.

Highlights – In April 2019, an initial meeting was held with a small group of tenants and senior leaders from the four sectors (city, housing, health, and community). This meeting took place on-site and was designed to get to know each other in an informal setting. The tenants had the opportunity to show the senior leaders their living environment and to make them aware of some of the issues they face on a daily basis.à

Working committees – During the citizens’ cafés, the tenants identified the priority issues on which they wished to work for the summer period. This is why, during the summer of 2019, committees were formed to develop concrete actions to address these issues: newspaper committee, washer-dryer committee, parking committee, health committee, and survey committee.

• Example of accomplishments: The Newspaper Committee – The objective of this committee was to produce an informative communication tool accessible to all the tenants of the plan. The mission of the committee, as defined by its members, is: to offer a cultural gathering, open to all; to transmit important information related to the partner sectors; to make people aware of the problems of low-income housing; to encourage reading; to have young people contribute to the project, to be models for them. The committee built the newspaper La Pépinière from nothing and worked on 3 editions. The Spring 2020 edition could not be published before the pandemic stopped activities.

Pandemic – In March 2020, all activities and group meetings with tenants were suspended to comply with public health measures. The facilitation team maintained regular contact with all tenants involved in the project by phone. We have not been able to maintain group activities remotely because most tenants have limited access to the internet. However, during the summer of 2020, it was possible for the facilitators to participate in outside activities organized by the Harmonie Project. The purpose of this presence was to reconnect with the tenants and the community, in preparation for a resumption of committee activities. Unfortunately, the second wave of the pandemic forced the fieldwork to stop once again.

Researchers

Janie Houle – Principal Researcher
Community Psychologist
Professor, Department of Psychology, UQÀM | Researcher, Research Centre of the University Institute in Mental Health of Montreal

Antoine Boivin
Family doctor
Professor, Department of Family Medicine, Université de Montréal
Professor, Department of Family Medicine, Université de Montréal | Researcher, CHUM Research Centre | Holder, Chaire de recherche du Canada sur le partenariat avec les patients et le public

Simon Coulombe
Community Psychologist
Professor, Department of Psychology, Wilfrid Laurier University

Jean-Marc Fontan
Sociologist
Professor, Departement of sociology, UQAM | Researcher, Centre de recherche sur les innovations sociales, UQAM

Katherine Frohlich
Professor, École de santé publique, Université de Montréal | Researcher, Institut de recherche en santé publique (IRSPUM)

Paul Morin
Sociologist
Professor, École de travail social, Université de Sherbrooke | Director, Institut universitaire de première ligne en santé et services sociaux

Juan Torres
Urbanist
Professor, École d’urbanisme et d’architecture du paysage, Université de Montréal

Research Staff

Hélène Gaudreau
Researcher agent, Departement of psychology, UQAM

Isabelle Lapointe
Ph. D. candidate, Departement of psychology, UQAM

Benoit Martel
Researcher agent, Departement of psychology, UQAM

Stéphanie Radziszewski
Ph. D. candidate, Departement of psychology, UQAM

Peer researchers

Over 30 peer researchers from the study community.

Partners

Lucie Caillière
Directror, Projet Harmonie

Danielle Cécile
CEO, Office municipal d’habitation de Montréal

Julie Frappier
Director, Mercier West Healthy Neighborhood

Sylvain Lemieux
CEO, CIUSSS de-l’Est-de-l’île-de-Montréal

Pierre Lessard-Blais
Mayor, Borough of Mercier Hochelaga-Maisonneuve

Coming soon.

Fonds de recherche du Québec (Concours AUDACE), $99 996.