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Plamondon KM, Shahram SZ. Defining equity, its determinants, and the foundations of equity science. Soc Sci Med 2024; 351:116940. [PMID: 38761454 DOI: 10.1016/j.socscimed.2024.116940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/23/2024] [Accepted: 05/01/2024] [Indexed: 05/20/2024]
Abstract
Advancing equity as a priority is increasingly declared in response to decades of evidence showing the association between poorer health outcomes and the unfair distribution of resources, power, and wealth across all levels of society. Quandries present, however, through incongruence, vagueness and disparate interpretations of the meaning of equity dilute and fragment efforts across research, policy and practice. Progress on reducing health inequities is, in this context, unsurprisingly irresolute. In this article, we make a case for equity science that reimagines the ways in which we (as researchers, as systems leaders, as teachers and mentors, and as citizens in society) engage in this work. We offer a definition of equity, its determinants, and the paradigmatic foundations of equity science, including the assumptions, values, and processes., and methods of this science. We argue for an equity science that can more meaningfully promote coherent alignment between intention, knowledge and action within and beyond the health sciences to spark a more equitable future.
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Affiliation(s)
- Katrina M Plamondon
- Equity Science Lab, Faculty of Health & Social Development, School of Nursing, University of British Columbia, ART360, 1147 Research Road, Kelowna, BC, Canada.
| | - Sana Z Shahram
- Equity Science Lab, Faculty of Health & Social Development, School of Nursing, University of British Columbia, ART360, 1147 Research Road, Kelowna, BC, Canada.
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2
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Jabali SH, Yazdani S, Pourasghari H, Maleki M. From bench to policy: a critical analysis of models for evidence-informed policymaking in healthcare. Front Public Health 2024; 12:1264315. [PMID: 38596514 PMCID: PMC11002157 DOI: 10.3389/fpubh.2024.1264315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background The use of research evidence in policy making is a complex and challenging process that has a long history in various fields, especially in healthcare. Different terms and concepts have been used to describe the relationship between research and policy, but they often lack clarity and consensus. To address this gap, several strategies and models have been proposed to facilitate evidence informed policy making and to identify the key factors and mechanisms involved. This study aims to critically review the existing models of evidence informed policy making (EIPM) in healthcare and to assess their strengths and limitations. Method A systematic search and review conducted to identify and critically assess EIPM models in healthcare. We searched PubMed, Web of Science and Scopus databases as major electronic databases and applied predefined inclusion criteria to select the models. We also checked the citations of the included models to find other scholars' perspectives. Each model was described and critiqued each model in detail and discussed their features and limitations. Result Nine models of EIPM in healthcare were identified. While models had some strengths in comprehension, flexibility and theoretical foundations, analysis also identified limitations including: presupposing rational policymaking; lacking alternatives for time-sensitive situations; not capturing policy complexity; neglecting unintended effects; limited context considerations; inadequate complexity concepts; limited collaboration guidance; and unspecified evidence adaptations. Conclusion The reviewed models provide useful frameworks for EIPM but need further improvement to address their limitations. Concepts from sociology of knowledge, change theory and complexity science can enrich the models. Future EIPM models should better account for the complexity of research-policy relationships and provide tailored strategies based on the policy context.
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Affiliation(s)
- Seyyed Hadi Jabali
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shahram Yazdani
- Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Pourasghari
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Maleki
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Phipps E, Bumstead L, Butt T, Crighton EJ, Desjardins N, Hart R, Oickle D, Sánchez-Pimienta CE, Schlonies R, Schonauer M, Umbach J, Masuda JR. 'It doesn't happen any other way': relationship-building and reflexivity for equity-focused intersectoral practice (EquIP). Health Promot Int 2023; 38:daad142. [PMID: 37966158 DOI: 10.1093/heapro/daad142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Intersectoral processes that bring together public institutions, civil society organizations and affected community members are essential to tackling complex health equity challenges. While conventional wisdom points to the importance of human relationships in fostering collaboration, there is a lack of practical guidance on how to do intersectoral work in ways that support authentic relationship-building and mitigate power differentials among people with diverse experiences and roles. This article presents the results of RentSafe EquIP, a community-based participatory research initiative conducted in Owen Sound, Canada, in the midst of a housing crisis. The research explored the potential utility of equity-focused intersectoral practice (EquIP), a novel approach that invests in human relationships and knowledge co-creation among professionals and affected members of the community. The three-phase EquIP methodology centred the grounded expertise of community members with lived/living experience of housing inadequacy to catalyze reflexive thinking by people in professional roles about the institutional gaps and barriers that prevent effective intersectoral response to housing-related inequities. The research demonstrated that EquIP can support agency professionals and community members to (i) engage in (re)problematization to redefine the problem statement to better include upstream drivers of inequity, (ii) support reflexivity among those in professional roles to identify institutional practices, policies and norms that perpetuate stigma and impede effective intersectoral response and (iii) spark individual and collective agency and commitment towards a more equity-focused intersectoral system. We conclude that the EquIP methodology is a promising approach for communities seeking to address persistent health equity and social justice challenges.
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Affiliation(s)
- Erica Phipps
- University of Ottawa, Ottawa, Ontario, Canada, K1N 8Z4
- Centre for Environmental Health Equity, Queen's University, Kingston, Ontario, Canada, K7L 3N6
- Canadian Partnership for Children's Health and Environment/RentSafe, Ottawa, Ontario, Canada
| | - Lynda Bumstead
- Grey Bruce Healthy Communities Partnership, Owen Sound, Ontario, Canada, N4K 0A5
| | - Tanya Butt
- RentSafe Tenants' Rights Advocate, Owen Sound, Ontario, Canada
- Community Voices, Owen Sound, Ontario, Canada, N4K 1P1
| | | | | | - Robert Hart
- Grey Bruce Public Health, Owen Sound, Ontario, Canada, N4K 0A5
| | - Dianne Oickle
- National Collaborating Centre for Determinants of Health, Antigonish, Nova Scotia, Canada, B2G 2W5
| | - Carlos E Sánchez-Pimienta
- Centre for Environmental Health Equity, Queen's University, Kingston, Ontario, Canada, K7L 3N6
- University of Toronto, Toronto, Ontario, Canada, M5T 3M7
| | - Renee Schlonies
- RentSafe Tenants' Rights Advocate, Owen Sound, Ontario, Canada
- Community Voices, Owen Sound, Ontario, Canada, N4K 1P1
| | - Misty Schonauer
- RentSafe Tenants' Rights Advocate, Owen Sound, Ontario, Canada
| | - Jill Umbach
- Bruce Grey Poverty Task Force, Owen Sound, Ontario, Canada, N4K 1P1
| | - Jeffrey R Masuda
- Centre for Environmental Health Equity, Queen's University, Kingston, Ontario, Canada, K7L 3N6
- University of Victoria, Victoria, British Columbia, Canada, V8W 2Y2
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Lefrançois M, Sultan-Taïeb H, Webb J, Gervais MJ, Messing K, Blanchette-Luong V, Riel J, Saint-Charles J, Faust R, Vaillancourt C, Fillion M, Laberge M. How to carry out participatory research that takes account of sex and gender issues: a scoping review of guidelines targeting health inequities. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:404-421. [PMID: 36752980 PMCID: PMC10283498 DOI: 10.17269/s41997-023-00742-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/05/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Conducting participatory research (PR) aimed at improving health implies considering inequitable power relations, including those related to sex/gender (S/G). This necessitates specific skills and methods and may be challenging especially since guidelines are scarce. Our objective was to perform a scoping review to provide a typology of existing guidelines for researchers on how to take account of S/G in the context of PR in public health, with a focus on occupational and environmental health. METHODS All steps of the research were conducted with the collaboration of an advisory committee, following PR principles. Nineteen documents were retained from 513 references identified in nine scientific databases and grey literature between 2000 and 2020. Data on recommendations were extracted and coded qualitatively. Cluster analysis based on similarities in recommendations proposed in the documents identified four types: (1) empowerment-centered; (2) concrete action-centered; (3) macrosystem-centered; and (4) stakeholder-centered. SYNTHESIS Many sources gave pointers on how to include S/G during data collection and analysis or during the dissemination of findings, but there was a dearth of suggestions for building partnerships with stakeholders and producing sustainable S/G sociopolitical transformations. Occupational health PR showed less similarities with other public health subfields including environmental health PR. Power relationships with workplace stakeholders generated specific obstacles related to S/G integration that require further attention. Intersectionality and reflexive practices emerged as overarching themes. CONCLUSION This review provides helpful guidelines to researchers at different stages of planning PR, ranging from familiarizing themselves with S/G approaches to anticipating difficulties in their ongoing S/G-transformative PR.
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Affiliation(s)
- Mélanie Lefrançois
- School of Management (ESG-UQAM), Université du Québec à Montréal (UQAM), Montreal, QC, Canada.
| | - Hélène Sultan-Taïeb
- School of Management (ESG-UQAM), Université du Québec à Montréal (UQAM), Montreal, QC, Canada
| | - Jena Webb
- CoPEH-Canada (Canadian Community of Practice in Ecosystem Approaches to Health), Université du Québec à Montréal (UQAM), Montreal, QC, Canada
| | - Mathieu-Joël Gervais
- Faculty of Social Sciences, Université du Québec à Montréal (UQAM), Montreal, QC, Canada
| | - Karen Messing
- Faculty of Sciences, Université du Québec à Montréal (UQAM), Montreal, QC, Canada
| | | | - Jessica Riel
- School of Management (ESG-UQAM), Université du Québec à Montréal (UQAM), Montreal, QC, Canada
| | - Johanne Saint-Charles
- Faculty of Communication, Université du Québec à Montréal (UQAM), Montreal, QC, Canada
| | - Rachel Faust
- School of Management (ESG-UQAM), Université du Québec à Montréal (UQAM), Montreal, QC, Canada
| | - Cathy Vaillancourt
- Centre Armand-Frappier Santé Biotechnologie, Institut national de recherche scientifique (INRS), Laval, QC, Canada
| | - Myriam Fillion
- Department of Science and Technology, Université TÉLUQ, Montreal, QC, Canada
| | - Marie Laberge
- School of Rehabilitation, Université de Montreal, Ste-Justine UHC Research Centre, Montreal, QC, Canada
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Cloke J, Hassan S, Goodall M, Ring A, Saini P, Tahir N, Gabbay M. Tapping into the power of coproduction and knowledge mobilisation: Exploration of a facilitated interactive group learning approach to support equity-sensitive decision-making in local health and care services. Health Expect 2023. [PMID: 37154125 DOI: 10.1111/hex.13774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND We report on a study of a facilitated interactive group learning approach, through Collaborative Implementation Groups (CIGs), established to enhance capacity for equity-sensitive evaluation of healthcare services to inform local decision-making: (1) What was the experience of participants of the CIGs? (2) How was knowledge mobilisation achieved? (3) What are the key elements that enhance the process of coproducing equity-sensitive evaluations? METHODS A thematic analysis of qualitative data obtained from focus group (FG) discussions and semistructured interviews exploring the experiences of participants. All FGs included representation of participants from different projects across the programme. Interviews were conducted with a member from each of the teams participating in the first cohort after their final workshop. RESULTS We identified four themes to illustrate how the approach to delivering intensive and facilitated training supported equity-sensitive evaluations of local healthcare services: (1) Creating the setting for coproduction and knowledge mobilisation; (2) establishing a common purpose, meaning and language for reducing health inequalities; (3) making connections and brokering relationships and (4) challenging and transforming the role of evaluation. CONCLUSION We report on the implementation of a practical example of engaged scholarship, where teams of healthcare staff were supported with resources, interactive training and methodological advice to evaluate their own services, enabling organisations to assemble timely practical and relevant evidence that could feed directly into local decision-making. By encouraging mixed teams of practitioners, commissioners, patients, the public and researchers to work together to coproduce their evaluations, the programme also aimed to systematise health equity into service change. The findings of our study illustrate that the approach to delivering training gave participants the tools and confidence to address their organisation's stated aims of reducing health inequalities, coproduce evaluations of their local services and mobilise knowledge from a range of stakeholders. PATIENT OR PUBLIC CONTRIBUTION The research question was developed collaboratively with researchers, partner organisations and public advisers (PAs). PAs were involved in meetings to agree on the focus of this research and to plan the analysis. N. T. is a PA and coauthor, contributing to the interpretation of findings and drafting of the paper.
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Affiliation(s)
- Jane Cloke
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Shaima Hassan
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Mark Goodall
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Adele Ring
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Pooja Saini
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Naheed Tahir
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- NIHR ARC NWC, Liverpool, UK
| | - Mark Gabbay
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Rabinowitz Bailey L, Ubri P, Stephens R, Redman S, Wiedt T, Watson L, Brown A. Advancing Health Equity Knowledge, Attitudes, and Beliefs Within a National Health Nonprofit Organization. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:39-46. [PMID: 36448757 DOI: 10.1097/phh.0000000000001640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE This study presents survey results assessing the impact of the American Cancer Society (ACS) health equity (HE) training on staff knowledge, attitudes, and beliefs about HE and social determinants of health (SDOH). DESIGN This study is a quasi-experimental design examining survey responses over time and comparing responses from staff who participated in ACS HE training sessions and education opportunities and those who did not. SETTING An electronic Web survey was distributed to all ACS and American Cancer Society Cancer Action Network (ACS CAN) staff in each of the 3 years that the training was held (2018-2020). PARTICIPANTS ACS and ACS CAN staff who chose to take the survey were included in the study. INTERVENTION Engagement with training hosted by the ACS HE team was examined. Training sessions were intended to introduce staff to HE and SDOH in the context of cancer outcomes and provide staff with the skills to become HE champions in the organization. MAIN OUTCOME MEASURES This study examines whether participation in training sessions hosted by the HE team had an impact on knowledge of HE terms, attitudes, and beliefs about HE and engagement with HE. RESULTS Trained respondents had a significantly higher HE knowledge summary score (98%) than those who were not trained (79%, SD = 0.26100, P < .001). Respondents who participated in training were more likely to believe that they could advance HE through their work at ACS and ACS CAN (88% compared with 66% of those who were not trained, SD = 0.47300, P < .001). Respondents who participated in training scored an average of 4.7 out of 6 on HE engagement compared with 3.8 among the untrained (SD = 1.425, P < .001). CONCLUSIONS These findings demonstrate that participation in HE training is associated with higher levels of knowledge about HE and stronger personal attitudes and beliefs about the importance of addressing SDOH. This is a foundational step in staff taking action to integrate HE concepts into their day-to-day work toward reducing inequities in access to cancer treatment and health outcomes.
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Affiliation(s)
- Lucy Rabinowitz Bailey
- NORC at the University of Chicago, Atlanta, Georgia (Mss Rabinowitz Bailey and Ubri and Drs Redman and Watson); ICF, Atlanta, Georgia (Dr Stephens); and American Cancer Society, Atlanta, Georgia (Mss Wiedt and Brown)
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Phipps E, Butt T, Desjardins N, Schonauer M, Schlonies R, Masuda JR. Lessons from a rural housing crisis: grounded insights for intersectoral action on health inequities. Soc Sci Med 2021; 270:113416. [PMID: 33487475 DOI: 10.1016/j.socscimed.2020.113416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/19/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022]
Abstract
Local communities are struggling with persistent health inequities driven by income disparity, housing inadequacy, and other intersecting factors that constrain individual and community well-being. Increasingly, intersectoral approaches are recognized as essential to tackle such challenges, given their intersecting nature. This paper describes Equity-focused Intersectoral Practice (EquIP), a novel methodology that merges participatory research principles with the purposeful positioning of grounded expertise (lived experience) to shift the gaze of intersectoral actors towards the contextual factors that contribute to health inequities. The EquIP methodology creates uncommon spaces for intersectoral encounter that support critical reflexivity and relationship-building among institutional and community-based intersectoral actors. A case example of the EquIP methodology, implemented in a small, rural Canadian city in the context of a regional housing crisis, illustrates how investment in reflexivity and relational praxis among diverse intersectoral actors supports the identification of existing structures, beliefs, and practices within institutional settings that constrain effective intersectoral response to health inequities.
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Affiliation(s)
- Erica Phipps
- Centre for Environmental Health Equity, School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, Ontario, K7L 3N6, Canada; Canadian Partnership for Children's Health and Environment, Ottawa, Ontario, Canada.
| | - Tanya Butt
- RentSafe Tenants' Rights Advocate, Owen Sound, Ontario, Canada; Community Voices, Owen Sound, Ontario, Canada
| | | | - Misty Schonauer
- RentSafe Tenants' Rights Advocate, Owen Sound, Ontario, Canada
| | - Renee Schlonies
- RentSafe Tenants' Rights Advocate, Owen Sound, Ontario, Canada; Community Voices, Owen Sound, Ontario, Canada
| | - Jeffrey R Masuda
- Centre for Environmental Health Equity, School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, Ontario, K7L 3N6, Canada; Department of Geography, Queen's University, 28 Division Street, Kingston, Ontario, K7L 3N6, Canada
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Younas A. Examining progression and degeneration of nursing science using Imre Lakatos's methodology of scientific research programs. Nurs Philos 2020; 22:e12342. [PMID: 33248002 DOI: 10.1111/nup.12342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/30/2020] [Accepted: 11/15/2020] [Indexed: 11/30/2022]
Abstract
Over the years, nursing research and practice have been through remarkable transformations in response to evolving and emerging healthcare systems and practices. Regarding research, nurses moved beyond merely using the quantitative methodology to combining qualitative, quantitative and mixed methods. In practice, nurses have transitioned from the delivery of medical-based care to nursing theory-guided practice, evidence-based practice, knowledge translation and transformative practice. Some domains of nursing research and practice became progressive, while others degenerated. This paper aims to examine how different domains of nursing research and practice progress and degenerate using Imre Lakatos's methodology of scientific research programs. Lakatos differentiated scientific and pseudoscientific knowledge and coined the idea of scientific research programs. He believed that science in any discipline develops so that some programs are more progressive and others' degenerative. The degeneration and progression of programs occur steadily and rationally and are determined based on the extent of development and programs' potential to predict new solutions to old problems. Adopting this idea could enable nurses to critically analyse research programs in everyday knowledge development to use valid and legitimate programs for informing nursing practice.
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Affiliation(s)
- Ahtisham Younas
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada.,Swat College of Nursing, Swat, Pakistan
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Falahat K, Baradaran Eftekhari M, Ebadifar A, Eltemasi M, Sobhani Z, Ghalenoee E, Habibi E. Knowledge production in Iranian social determinants of health research centers: Toward health equity. Med J Islam Repub Iran 2020; 34:58. [PMID: 32934947 PMCID: PMC7481857 DOI: 10.34171/mjiri.34.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Indexed: 11/21/2022] Open
Abstract
Background: As the partner country of the WHO Commission on Social Determinants of Health (SDH), Iran has expanded the knowledge based on the social determinants of health- as one of commission recommendations- by establishing SDH research centers to collect evidence and design responses to the existing health equity gap. Considering the importance of the role assigned to these research centers, this study aimed to present the knowledge production of SDH research centers and determine their status in Iran's health research system (HRS). Methods: In this cross sectional study, research performance of SDH research centers was assessed based on international research indicators and compared with national medical research centers and HRS knowledge production. Then, SDH research centers were scored and ranked based on the research indicators. Results: Out of 37 approved SDH research centers, the knowledge performance of 33 research centers was reviewed. The total number of academic members was 334. The number of these centers' indexed published articles and the proportion of published articles per academic member have been doubled from 483 and 1.44 in 2015 to 984 and 2.94 in 2017. In this period, the number of citations of the past 5-year publications was 4355 according to Scopus database. The proportions of these centers' high-quality publication (Q1) and international collaborations per published articles were 14.8 and 8.25. In ranking, the first to third ranks were occupied by SDH research centers of Kermanshah, Kurdistan, and Qazvin Universities of Medical Sciences. Conclusion: Although knowledge production seems desirable in mentioned research centers, it is essential to create a virtual research network to increase intersectoral collaboration and develop strategies to solve the puzzle of gathering evidence on the social determinants affecting health inequities.
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Affiliation(s)
- Katayoun Falahat
- Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Asghar Ebadifar
- Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Department of Orthodontics, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Eltemasi
- Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Zahra Sobhani
- Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Elham Ghalenoee
- Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Elham Habibi
- Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
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Anne G, Émilie T, Kareen N, Ginette L, Valéry R. Adapting a health equity tool to meet professional needs (Québec, Canada). Health Promot Int 2020; 34:e71-e83. [PMID: 30107463 DOI: 10.1093/heapro/day047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
While numerous tools are available to better incorporate equity into population health actions, they are limited mainly by their lack of adaptation to professional practices and organizational realities. A study was conducted in Québec to identify and understand, from the perspective of future users, conditions that would facilitate use of a tool (Reflex-ISS) targeted at supporting collaborative action to improve consideration of social inequalities in health (SIH) within population health actions. Concept mapping and focus groups were implemented as complementary methods for investigating the conditions. Significant results that emerged were strong participant interest in the tool and the need for resources to better take SIH into account. The conditions for use that were identified referred to the tool itself (user-friendliness and literacy) and to resources for appropriating the tool, competency development, as well as the role and responsibilities of organizations and policies in promoting use of the tool in daily activities and more fundamentally in acting against SIH in general. Models for organizational innovation give an idea of the dimensions that need to be considered to strengthen the integration of equity into organizations and to support the changes in practice that result from using the tool. They provide a reminder that a health equity tool cannot be the cornerstone of an organizational strategy to fight against SIH; rather, it must be incorporated as part of a systemic strategy of professional and organizational development.
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Affiliation(s)
| | | | - Nour Kareen
- Direction de santé publique de la Montérégie, Longueuil, Québec, Canada
| | | | - Ridde Valéry
- IRD (French Institute For Research on Sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD.,Université de Montréal Public Health Research Institute (IRSPUM), Québec, Canada
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11
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Alexander SA, Jones CM, Tremblay MC, Beaudet N, Rod MH, Wright MT. Reflexivity in Health Promotion: A Typology for Training. Health Promot Pract 2020; 21:499-509. [PMID: 32285696 PMCID: PMC7298350 DOI: 10.1177/1524839920912407] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Reflexivity has emerged as a key concept in the field of health promotion
(HP). Yet it remains unclear how diverse forms of reflexivity are
specifically relevant to HP concerns, and how these “reflexivities”
are interconnected. We argue that frameworks are needed to support
more systematic integration of reflexivity in HP training and
practice. In this article, we propose a typology of reflexivity in HP
to facilitate the understanding of reflexivity in professional
training. Drawing from key theories and models of reflexivity, this
typology proposes three reflexive positions (ideal-types) with
specific purposes for HP: reflexivity in, on, and underlying action.
This article illustrates our typology’s ideal-types with vignettes
collected from HP actors working with reflexivity in North America and
Europe. We suggest that our typology constitutes a conceptual device
to organize and discuss a variety of experiences of engaging with
reflexivity for HP. We propose the typology may support integrating
reflexivity as a key feature in training a future cadre of health
promoters and as a means for building a responsible HP practice.
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Affiliation(s)
| | | | | | - Nicole Beaudet
- Montreal Health and Social Services Agency, Montreal, Canada
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12
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Plamondon KM. A tool to assess alignment between knowledge and action for health equity. BMC Public Health 2020; 20:224. [PMID: 32050946 PMCID: PMC7017559 DOI: 10.1186/s12889-020-8324-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 02/05/2020] [Indexed: 12/02/2022] Open
Abstract
Advancing health equity is a central goal and ethical imperative in public and global health. Though the commitment to health equity in these fields and among the health professions is clear, alignment between good equity intentions and action remains a challenge. This work regularly encounters the same power structures that are known to cause health inequities. Despite consensus about causes, health inequities persist-illustrating an uncomfortable paradox: good intentions and good evidence do not necessarily lead to meaningful action. This article describes a theoretically informed, reflective tool for assessing alignment between knowledge and action for health equity. It is grounded in an assumption that progressively more productive action toward health inequities is justified and desired and an explicit acceptance of the evidence about the socioeconomic, political, and power-related root causes of health inequities. Intentionally simple, the tool presents six possible actions that describe ways in which health equity work could respond to causes of health inequities: discredit, distract, disregard, acknowledge, illuminate, or disrupt. The tool can be used to assess or inform any kind of health equity work, in different settings and at different levels of intervention. It is a practical resource against which practice, policy, or research can be held to account, encouraging steps toward equity- and evidence-informed action. It is meant to complement other tools and training resources to build capacity for allyship, de- colonization, and cultural safety in the field of health equity, ultimately contributing to growing awareness of how to advance meaningful health equity action.
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Affiliation(s)
- Katrina Marie Plamondon
- University of British Columbia, 1147 Research Road, Kelowna, BC, Canada.
- Regional Practice Leader, Research & Knowledge Translation, Research Department, Interior Health, Kelowna, BC, Canada.
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Hazel YP, Malla C, Afford A, Hillgrove T, Gurung R, Dahal A, Shah S, Shrestha MK, Manandhar A. Continuous Knowledge Translation in Action: Designing a Programmatic Research Trial for Equitable Eye Health for Rural Nepalese Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010345. [PMID: 31947881 PMCID: PMC6981358 DOI: 10.3390/ijerph17010345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 12/31/2022]
Abstract
Reaching vulnerable populations through programmatic eye health interventions requires a focus on not only the intervention strategies, but the adaptability of the program design process itself. Knowing who is left behind and why solutions that will be effective on the ground at the time of implementation are not necessarily generated. There is a need for eye health programmatic design processes that can trial interventions and allow for continuous knowledge translation along the way. In rural Nepal, women are impacted by multiple and interconnected determinants of health, as well as unique barriers to accessing information and services, requiring targeted programming strategies. This article describes a programmatic design and knowledge translation process that aims to increase women’s uptake of eye health services in rural Nepal. The article outlines key learnings of this knowledge translation process, and how this may contribute to addressing gender equity in eye health.
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Affiliation(s)
- Yadira Perez Hazel
- Fred Hollows Foundation, Melbourne, VIC 3053, Australia;
- Correspondence: (Y.P.H.); (C.M.)
| | - Cathy Malla
- Fred Hollows Foundation, Darwin, NT 0810, Australia;
- Correspondence: (Y.P.H.); (C.M.)
| | - Anita Afford
- Fred Hollows Foundation, Darwin, NT 0810, Australia;
| | | | - Reeta Gurung
- Tilganga Institute of Ophthalmology, Kathmandu 44600, Nepal; (R.G.); (S.S.); (M.K.S.); (A.M.)
| | - Anjila Dahal
- Fred Hollows Foundation, Kathmandu 44600, Nepal;
| | - Sarita Shah
- Tilganga Institute of Ophthalmology, Kathmandu 44600, Nepal; (R.G.); (S.S.); (M.K.S.); (A.M.)
| | - Mohan Krishna Shrestha
- Tilganga Institute of Ophthalmology, Kathmandu 44600, Nepal; (R.G.); (S.S.); (M.K.S.); (A.M.)
| | - Anu Manandhar
- Tilganga Institute of Ophthalmology, Kathmandu 44600, Nepal; (R.G.); (S.S.); (M.K.S.); (A.M.)
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Plamondon KM, Caxaj CS, Graham ID, Bottorff JL. Connecting knowledge with action for health equity: a critical interpretive synthesis of promising practices. Int J Equity Health 2019; 18:202. [PMID: 31878940 PMCID: PMC6933619 DOI: 10.1186/s12939-019-1108-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/10/2019] [Indexed: 11/12/2022] Open
Abstract
Connecting knowledge with action (KWA) for health equity involves interventions that can redistribute power and resources at local, national, and global levels. Although there is ample and compelling evidence on the nature, distribution, and impact of health inequities, advancing health equity is inhibited by policy arenas shaped by colonial legacies and neoliberal ideology. Effective progress toward health equity requires attention to evidence that can promote the kind of socio-political restructuring needed to address root causes of health inequities. In this critical interpretive synthesis, results of a recent scoping review were broadened to identify evidence-informed promising practices for KWA for health equity. Following screening procedures, 10 literature reviews and 22 research studies were included in the synthesis. Analysis involved repeated readings of these 32 articles to extract descriptive data, assess clarity and quality, and identify promising practices. Four distinct kinds of promising practices for connecting KWA for health equity were identified and included: ways of structuring systems, ways of working together, and ways of doing research and ways of doing knowledge translation. Our synthesis reveals that advancing health equity requires greater awareness, dialogue, and action that aligns with the what is known about the causes of health inequities. By critically reflecting on dominant discourses and assumptions, and mobilizing political will from a more informed and transparent democratic exercise, knowledge to action for health equity can be achieved.
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Affiliation(s)
- Katrina M Plamondon
- School of Nursing, The University of British Columbia, 1147 Research Rd., ART 360, Kelowna, BC, V1V 1V7, Canada.
| | | | - Ian D Graham
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada
| | - Joan L Bottorff
- School of Nursing, The University of British Columbia, 1147 Research Rd., ART 360, Kelowna, BC, V1V 1V7, Canada
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Plamondon KM, Pemberton J. Blending integrated knowledge translation with global health governance: an approach for advancing action on a wicked problem. Health Res Policy Syst 2019; 17:24. [PMID: 30832660 PMCID: PMC6399857 DOI: 10.1186/s12961-019-0424-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The persistence of health inequities is a wicked problem for which there is strong evidence of causal roots in the maldistribution of power, resources and money within and between countries. Though the evidence is clear, the solutions are far from straightforward. Integrated knowledge translation (IKT) ought to be well suited for designing evidence-informed solutions, yet current frameworks are limited in their capacity to navigate complexity. Global health governance (GHG) also ought to be well suited to advance action, but a lack of accountability, inclusion and integration of evidence gives rise to politically driven action. Recognising a persistent struggle for meaningful action, we invite contemplation about how blending IKT with GHG could leverage the strengths of both processes to advance health equity. DISCUSSION Action on root causes of health inequities implicates disruption of structures and systems that shape how society is organised. This infinitely complex work demands sophisticated examination of drivers and disrupters of inequities and a vast imagination for who (and what) should be engaged. Yet, underlying tendencies toward reductionism seem to drive superficial responses. Where IKT models lack consideration of issues of power and provide little direction for how to support cohesive efforts toward a common goal, recent calls from the field of GHG may provide insight into these issues. Additionally, though GHG is criticised for its lack of attention to using evidence, IKT offers approaches and strategies for collaborative processes of generating and refining knowledge. Contemplating the inclusion of governance in IKT requires re-examining roles, responsibilities, power and voice in processes of connecting knowledge with action. We argue for expanding IKT models to include GHG as a means of considering the complexity of issues and opening new possibilities for evidence-informed action on wicked problems. CONCLUSION Integrated learning between these two fields, adopting principles of GHG alongside the strategies of IKT, is a promising opportunity to strengthen leadership for health equity action.
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Affiliation(s)
- Katrina Marie Plamondon
- University of British Columbia, 3333 University Way, Kelowna, BC Canada
- Interior Health, 505 Doyle Avenue, Kelowna, BC Canada
| | - Julia Pemberton
- McMaster University, 1280 Main Street West, Hamilton, ON Canada
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Tyler I, Pauly B, Wang J, Patterson T, Bourgeault I, Manson H. Evidence use in equity focused health impact assessment: a realist evaluation. BMC Public Health 2019; 19:230. [PMID: 30808317 PMCID: PMC6390302 DOI: 10.1186/s12889-019-6534-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Equity-focused health impact assessment (EFHIA) can function as a framework and tool that supports users to collate data, information, and evidence related to health equity in order to identify and mitigate the impact of a current or proposed initiative on health inequities. Despite education efforts in both the clinical and public health settings, practitioners have found implementation and the use of evidence in completing equity focussed assessment tools to be challenging. METHODS We conducted a realist evaluation of evidence use in EFHIA in three phases: 1) developing propositions informed by a literature scan, existing theoretical frameworks, and stakeholder engagement; 2) data collection at four case study sites using online surveys, semi-structured interviews, document analysis, and observation; and 3) a realist analysis and identification of context-mechanism-outcome patterns and demi-regularities. RESULTS We identified limited use of academic evidence in EFHIA with two explanatory demi-regularities: 1) participants were unable to "identify with" academic sources, acknowledging that evidence based practice and use of academic literature was valued in their organization, but seen as less likely to provide answers needed for practice and 2) use of academic evidence was not associated with a perceived "positive return on investment" of participant energy and time. However, we found that knowledge brokering at the local site can facilitate evidence familiarity and manageability, increase user confidence in using evidence, and increase the likelihood of evidence use in future work. CONCLUSIONS The findings of this study provide a realist perspective on evidence use in practice, specifically for EFHIA. These findings can inform ongoing development and refinement of various knowledge translation interventions, particularly for practitioners delivering front-line public health services.
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Affiliation(s)
| | - Bernie Pauly
- School of Nursing, Scientist, Canadian Institute for Substance Use Research, UVIC Community Engaged Scholar , University of Victoria, Victoria, BC, Canada
| | | | | | - Ivy Bourgeault
- Telfer School of Management, the University of Ottawa, Canadian Institutes of Health Research Chair in Gender, Work and Health Human Resources, Ottawa, Canada
| | - Heather Manson
- Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
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Guichard A, Hébert C, Nour K, Lafontaine G, Tardieu É, Ridde V. [Adaptation and conditions of use of a health equity tool: The Reflex-ISS tool]. SANTE PUBLIQUE 2019; 30:121-130. [PMID: 30547477 DOI: 10.3917/spub.184.0121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Although actions to reduce social inequalities in health cannot be considered the exclusive responsibility of public health actors, they should at least make sure their interventions account for these inequalities. However, the actors involved in these interventions have few tools to support them in this process. Therefore, building on a study conducted in France, we have adapted, tested, and developed in Quebec a tool intended to help actors take into account social inequalities in health. The article presents the approach that led to the adaptation of the tool to the Quebec context, to describe the tool, and then to discuss some issues for inclusion in professional practices. A participatory and constructive process between researchers, managers and practitioners led to a useful and useable tool. It is composed of five aspects of intervention (planning, implementation, evaluation, sustainability, and empowerment) and 44 items for discussion presented as questions. A user guide, a glossary, and some practical examples accompany the tool. It follows a reflexive and constructive process wherein a third party facilitator can assist actors involved in an intervention to analyze how they take social inequalities in health into account. This assessment can help generate collective recommendations for improvements, which can be monitored over time, to improve consideration of equity in public health interventions. The article concludes on some issues related to its integration into professional practices.
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Plamondon KM, Bottorff JL, Caxaj CS, Graham ID. The integration of evidence from the Commission on Social Determinants of Health in the field of health equity: a scoping review. CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2018.1551613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Katrina M. Plamondon
- Interdisciplinary Graduate Studies, University of British Columbia, Kelowna, Canada
- School of Nursing, University of British Columbia, Kelowna, Canada
| | - Joan L. Bottorff
- School of Nursing, University of British Columbia, Kelowna, Canada
| | - C. Susana Caxaj
- School of Nursing, University of British Columbia, Kelowna, Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada
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Phipps E, Masuda JR. Towards equity-focused intersectoral practice (EquIP) in children's environmental health and housing: the transformational story of RentSafe. Canadian Journal of Public Health 2018; 109:379-385. [PMID: 29981107 PMCID: PMC6153698 DOI: 10.17269/s41997-018-0094-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/28/2018] [Indexed: 11/18/2022]
Abstract
Setting This paper chronicles the transformational process through which a national intersectoral collaboration, the Canadian Partnership for Children’s Health and Environment (CPCHE), came to embrace a more upstream, equity-based focus in its mandate to advance children’s environmental health. Intervention After 15 years of working within a conventional, evidence-informed approach to health promotion and policy advocacy, in 2010–2013, CPCHE had the opportunity to collaborate on the development of equity-focused knowledge translation (EqKT). EqKT is a relational approach to knowledge practices that challenges intersectoral actors to work to uncover biases and limitations within their own institutional paradigms and professional practices that constrain their capacity to address population health inequities. Outcome The ensuing transformation towards equity-focused intersectoral practice led CPCHE to create an intersectoral initiative called RentSafe. Conceptually and operationally, RentSafe provides an intersectoral space within which the grounded expertise of people with experience of unhealthy and undignified housing provides a roadmap for public health and other practitioners to critically explore professional and institutional blind spots and barriers. With RentSafe as its watershed moment, CPCHE is shifting from a top-down “for whom” orientation to an authentically engaged “with whom” approach that seeks to work integrally with community partners to expose and challenge systemic roots of health inequity. Implications The transformational story of CPCHE underscores the competencies needed for public health professionals to acknowledge the sources of our own biases and limitations as a necessary first step in equity-focused intersectoral practice (EquIP). It also affirms the value of working in partnership with those who experience the environmental health inequities that such efforts seek to address.
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Affiliation(s)
- Erica Phipps
- Canadian Partnership for Children's Health and Environment (CPCHE), Toronto, ON, Canada. .,School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON, K7L 3N6, Canada. .,Centre for Environmental Health Equity (CEHE), Kingston, Canada.
| | - Jeffrey R Masuda
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON, K7L 3N6, Canada.,Centre for Environmental Health Equity (CEHE), Kingston, Canada.,Department of Geography, Queen's University, 28 Division Street, Kingston, ON, K7L 3N6, Canada
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Critical considerations for the practical utility of health equity tools: a concept mapping study. Int J Equity Health 2018; 17:48. [PMID: 29688855 PMCID: PMC5914026 DOI: 10.1186/s12939-018-0764-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 04/12/2018] [Indexed: 12/03/2022] Open
Abstract
Background Promoting health equity within health systems is a priority and challenge worldwide. Health equity tools have been identified as one strategy for integrating health equity considerations into health systems. Although there has been a proliferation of health equity tools, there has been limited attention to evaluating these tools for their practicality and thus their likelihood for uptake. Methods Within the context of a large program of research, the Equity Lens in Public Health (ELPH), we conducted a concept mapping study to identify key elements and themes related to public health leaders and practitioners’ views about what makes a health equity tool practical and useful. Concept mapping is a participatory mixed-method approach to generating ideas and concepts to address a common concern. Participants brainstormed responses to the prompt “To be useful, a health equity tool should…” After participants sorted responses into groups based on similarity and rated them for importance and feasibility, the statements were analyzed using multidimensional scaling, then grouped using cluster analysis. Pattern matching graphs were constructed to illustrate the relationship between the importance and feasibility of statements, and go-zone maps were created to guide subsequent action. Results The process resulted in 67 unique statements that were grouped into six clusters: 1) Evaluation for Improvement; 2) User Friendliness; 3) Explicit Theoretical Background; 4) Templates and Tools 5) Equity Competencies; and 6) Nothing about Me without Me- Client Engaged. The result was a set of concepts and themes describing participants’ views of the practicality and usefulness of health equity tools. Conclusions These thematic clusters highlight the importance of user friendliness and having user guides, templates and resources to enhance use of equity tools. Furthermore, participants’ indicated that practicality was not enough for a tool to be useful. In addition to practical characteristics of the tool, a useful tool is one that encourages and supports the development of practitioner competencies to engage in equity work including critical reflections on power and institutional culture as well as strategies for the involvement of community members impacted by health inequities in program planning and delivery. The results of this study will be used to inform the development of practical criteria to assess health equity tools for application in public health.
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McKillop A, Shaw J, Sheridan N, Gray CS, Carswell P, Wodchis WP, Connolly M, Denis JL, Baker GR, Kenealy T. Understanding the Attributes of Implementation Frameworks to Guide the Implementation of a Model of Community-based Integrated Health Care for Older Adults with Complex Chronic Conditions: A Metanarrative Review. Int J Integr Care 2017; 17:10. [PMID: 28970751 PMCID: PMC5624227 DOI: 10.5334/ijic.2516] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 04/24/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Many studies have investigated the process of healthcare implementation to understand better how to bridge gaps between recommended practice, the needs and demands of healthcare consumers, and what they actually receive. However, in the implementation of integrated community-based and integrated health care, it is still not well known which approaches work best. METHODS We conducted a systematic review and metanarrative synthesis of literature on implementation frameworks, theories and models in support of a research programme investigating CBPHC for older adults with chronic health problems. RESULTS Thirty-five reviews met our inclusion criteria and were appraised, summarised, and synthesised. Five metanarratives emerged 1) theoretical constructs; 2) multiple influencing factors; 3) development of new frameworks; 4) application of existing frameworks; and 5) effectiveness of interventions within frameworks/models. Four themes were generated that exposed the contradictions and synergies among the metanarratives. Person-centred care is fundamental to integrated CBPHC at all levels in the health care delivery system, yet many implementation theories and frameworks neglect this cornerstone. DISCUSSION The research identified perspectives central to integrated CBPHC that were missing in the literature. Context played a key role in determining success and in how consumers and their families, providers, organisations and policy-makers stay connected to implementing the best care possible. CONCLUSIONS All phases of implementation of a new model of CBPHC call for collaborative partnerships with all stakeholders, the most important being the person receiving care in terms of what matters most to them.
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Guichard A, Tardieu É, Dagenais C, Nour K, Lafontaine G, Ridde V. Use of concurrent mixed methods combining concept mapping and focus groups to adapt a health equity tool in Canada. EVALUATION AND PROGRAM PLANNING 2017; 61:169-177. [PMID: 28160690 DOI: 10.1016/j.evalprogplan.2017.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/04/2017] [Indexed: 06/06/2023]
Abstract
The aim of this project was to identify and prioritize a set of conditions to be considered for incorporating a health equity tool into public health practice. Concept mapping and focus groups were implemented as complementary methods to investigate the conditions of use of a health equity tool by public health organizations in Quebec. Using a hybrid integrated research design is a richer way to address the complexity of questions emerging from intervention and planning settings. This approach provides a deeper, operational, and contextualized understanding of research results involving different professional and organizational cultures, and thereby supports the decision-making process. Concept mapping served to identify and prioritize in a limited timeframe the conditions to be considered for incorporation into a health equity tool into public health practices. Focus groups then provided a more refined understanding of the barriers, issues, and facilitating factors surrounding the tools adoption, helped distinguish among participants' perspectives based on functional roles and organizational contexts, and clarified some apparently contradictory results from the concept map. The combined use of these two techniques brought the strengths of each approach to bear, thereby overcoming some of the respective limitations of concept mapping and focus groups. This design is appropriate for investigating targets with multiple levels of complexity.
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Affiliation(s)
| | | | | | - Kareen Nour
- Direction de santé publique de la Montérégie, Longueuil, Quebec, Canada
| | | | - Valéry Ridde
- Université de Montréal School of Public Health (ESPUM), Université de Montréal Public Health Research Institute (IRSPUM), Québec, Canada
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Haynes E, Hohnen H, Katzenellenbogen JM, Scalley BD, Thompson SC. Knowledge translation lessons from an audit of Aboriginal Australians with acute coronary syndrome presenting to a regional hospital. SAGE Open Med 2016; 4:2050312116661114. [PMID: 27516880 PMCID: PMC4968102 DOI: 10.1177/2050312116661114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/27/2016] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Translation of evidence into practice by health systems can be slow and incomplete and may disproportionately impact disadvantaged populations. Coronary heart disease is the leading cause of death among Aboriginal Australians. Timely access to effective medical care for acute coronary syndrome substantially improves survival. A quality-of-care audit conducted at a regional Western Australian hospital in 2011-2012 compared the Emergency Department management of Aboriginal and non-Aboriginal acute coronary syndrome patients. This audit is used as a case study of translating knowledge processes in order to identify the factors that support equity-oriented knowledge translation. METHODS In-depth interviews were conducted with a purposive sample of the audit team and further key stakeholders with interest/experience in knowledge translation in the context of Aboriginal health. Interviews were analysed for alignment of the knowledge translation process with the thematic steps outlined in Tugwell's cascade for equity-oriented knowledge translation framework. RESULTS In preparing the audit, groundwork helped shape management support to ensure receptivity to targeting Aboriginal cardiovascular outcomes. Reporting of audit findings and resulting advocacy were undertaken by the audit team with awareness of the institutional hierarchy, appropriate timing, personal relationships and recognising the importance of tailoring messages to specific audiences. These strategies were also acknowledged as important in the key stakeholder interviews. A follow-up audit documented a general improvement in treatment guideline adherence and a reduction in treatment inequalities for Aboriginal presentations. CONCLUSION As well as identifying outcomes such as practice changes, a useful evaluation increases understanding of why and how an intervention worked. Case studies such as this enrich our understanding of the complex human factors, including individual attributes, experiences and relationships and systemic factors that shape equity-oriented knowledge translation. Given the potential that improving knowledge translation has to close the gap in Aboriginal health disparities, we must choose strategies that adequately take into account the unique contingencies of context across institutions and cultures.
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Affiliation(s)
- Emma Haynes
- The University of Western Australia, Crawley, WA, Australia
| | - Harry Hohnen
- The University of Western Australia, Crawley, WA, Australia
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Enabling the transferability of complex interventions: exploring the combination of an intervention's key functions and implementation. Int J Public Health 2016; 61:1031-1038. [PMID: 27063950 DOI: 10.1007/s00038-016-0809-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 02/27/2016] [Accepted: 03/11/2016] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Several public health interventions are not described, not evaluated and not transferred. The objective was to assess the feasibility and acceptability of using a description model making a distinction between interventions' transferable elements, and those that are more context-specific, to make their evaluation and transferability easier. METHODS The theoretical distinction between an intervention function and its form in a specific context has been empirically explored. A community-based intervention (named "Ciné-Ma-Santé") has been described, using a "key function/implementation/context" model. This process has been co-constructed through qualitative research and knowledge exchange process between project leaders and researchers from different disciplines. RESULTS The use of the model proves feasible and useful for both project leaders and researchers. Nine key functions were described, as well as their implementation and the features of the intervention context. CONCLUSIONS Rendering explicit key functions of public health interventions could constitute a useful step to their evaluation and transfer. It enables the formulation of hypotheses regarding the potentially standardizable elements of interventions, and elements that can be modified while maintaining the integrity of the intervention.
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