Study context This research was conducted as part of the INTErventions, Research, and Action in Cities Team (INTERACT), a research collaboration of scientists, urban planners, and engaged community members uncovering how the design of our cities is shaping the health and well-being of Canadians (22). In Montreal, INTERACT assesses built environment interventions that are related to the Plan Montréal durable 2016–2020, a metropolitan-wide sustainability plan. Grounded in this sustainability focus, although not specific to this Plan Montreal durable, this concept mapping exercise assessed both community members’ perspectives on desired interventions, and stakeholders’ perspectives on success factors of an intervention. While community members are key stakeholders in any urban change project, we sought to study their specific perspectives as local experts on desired changes; they therefore form a separate group from the stakeholder group.
Recruitment The community member group was assembled by inviting a random subsample of 100 participants from the INTERACT cohort (25 Anglophones and 75 Francophones, corresponding to the linguistic breakdown in Montreal) to participate. Participants had to live on the Island of Montreal, or in Laval, Longueuil, Brossard and Saint-Lambert. In parallel, we invited 150 stakeholders, identified through the INTERACT Advisory Committee. This committee comprises professionals from the City of Montreal, the Montreal public health department (Direction régionale de la santé publique), and NGOs that advocate for issues surrounding health promotion, physical activity policy, inclusion, active transportation, and urban planning. Stakeholders were also encouraged to share the invitation to join the study within their organization and broader professional network. All participants had to be aged 18 years and older. Ethics approval was received by the Comité d’éthique de recherche at CHUM (2017–7024, CE 16.397 - ID).
Overview of the concept mapping process: The concept mapping process has three phases: 1. Statement generation and subsequent reduction, 2. Statement sorting and rating, analysis and generation of maps, and 3. Concept map interpretation and naming of clusters. (23). Phase 3 is often done with participants but can also be done by a research team. For this exercise, the research team proposed the cluster names, and validated and refined these with the Advisory Committee during an interpretation workshop.
Data Collection and Analysis: PHASE 1 Statement generation – November 2018 We provided stakeholders and community members links to separate web-based concept mapping exercise (Insight Forming, Polygon Research Inc.). The exercise was administered in both English and French for the community member group, and in French only for the stakeholder group (as the mandatory working language in Quebec). Participants in the community group were asked to respond to the following prompt: In your opinion, what interventions should be put in place in your neighbourhood to improve your quality of life and that of your fellow citizens? [French : Selon vous, quelles interventions devraient être mises en place dans votre quartier pour améliorer votre qualité de vie et celle de vos concitoyens?] Demographic information on participants was drawn from INTERACT cohort data collection, launched the same year (June 2018). Participants in the stakeholder group were asked to provide information on their role, duration in that role, type of organization, and whether they were partners on the Plan Montréal durable. Stakeholders then responded to the following prompt: In order to improve the quality of life of citizens and contribute to the sustainable development of cities, we must intervene on the built environment. Based on your experience, what are the factors that contribute to successful interventions? [French : En vue d’améliorer la qualité de vie des citoyens et de contribuer au développement durable des villes, il faut intervenir sur le cadre bâti. En vous basant sur votre expérience, quels sont les facteurs qui contribuent à des interventions réussies?]
Once the brainstorming phase was complete, the research team reviewed the statements generated by stakeholders. Duplicate or similar statements were removed, multiple concepts within one statement were separated, and the statements were edited for clarity (spelling, grammar). The number of items was reduced to roughly 40 ahead of Phase 2, to ease participation for the next steps. For the community group, the bilingual research team translated items generated in Phase 1 to ensure the full set of ideas was ranked and rated in Phase 2 by both Francophone and Anglophone participants.
PHASE 2 Statement sorting and ranking- December 2018-March 2019: In this next phase, we asked both the community group and stakeholder group to use the online application to: 1) Sort the list of statements into conceptually similar piles and give the piles a short title; and 2) Rate each statement using a Likert scale from one to four along two criteria: importance and feasibility (1 = not important / not feasible at all to 4 = very important / very feasible). Multiple reminders were sent and the participation period was extended to allow for higher participation.
Each participant's sorting of items provides a square proximity matrix identifying which statements were sorted together. The sum of these individual matrices provides the co-occurrence between concepts based on the group of participants. The concept mapping approach uses these data to produce concept maps through cluster analysis and multidimensional scaling. A Ward cluster analysis was run to identify groups of concepts that belong together, using the ‘cluster’ (version 2.0.3) (24) and ‘NbClust’ (version 3.0) R packages (25). Multidimensional scaling using the R-package ‘vegan’ (version 2.3–1) (26) projects the proximity matrix on a two-dimension map, and visualize the relative position of the statements and clusters. Silhouette scores, a measure that indicates the similarity of a statement to the cluster it is assigned to (cohesion) relative to other clusters (separation), were used to examine the number and relevance of potential clustering solutions (27). To optimise cluster solutions, items with negative silhouette coefficients indicating they may have been sorted quite differently or simply left unsorted by participants were removed. The quality of the dimensional projection was evaluated using the Kruskal Stress Index knowing that a stress value of 0.20 or lower is considered desirable (28). The analysis procedures were conducted separately for each group.
PHASE 3. Map Interpretation and Matrix Creation October 2019 - To interpret the resulting concept maps, the research team gathered the Advisory Committee (of which some members had participated in Phases 1 and 2) to review the proposed names of the clusters. Then, the main clusters or themes emerging from community members’ vision about desired neighbourhood interventions (the what?) were combined with stakeholders’ understanding of factors contributing to successful implementation (the how?) in a matrix. This Community x Stakeholder Matrix was then used as a tool during an interpretation workshop held at the Université de Montréal Hospital Research Center on October 2nd, 2019, to frame an evaluative discussion on sustainability programs and policies with the Advisory Committee.